Minnesota Hospital Association

Newsroom

May 29, 2015

Health Care Leader

In this issue 

Summer Trustee Conference held July 10-12

The MHA 29th Annual Summer Trustee Conference, themed “Strategies for Effective Governance,” will be held July 10-12, at the Arrowwood Resort and Conference Center in Alexandria. Conference highlights include presentations from Studer Group speaker, strategist, and author Liz Jazweic; recently retired local broadcast journalist Don Shelby; and internationally known speaker and award winning author Rob Quillens. 

  • Liz Jazweic, R.N., will describe why it is so important to acknowledge our accomplishments and focus on all the good things about health care in her presentation, “Promoting Pride in Health Care.” 
  • With more than 45 year experience as a broadcast journalist, Don Shelby will share his wealth of learning and experience in his enlightening presentation, “Lessons Learned from the World of Journalism.” 
  • Rob Quillens will share how a random meeting with a perfect stranger the day before 9/11 changed his life and how it will forever change yours in his presentation, “Why Wait: Helping Dreams Come True.” 

For more information or to register, download the conference brochure or visit the MHA websiteReturn to top    

All’s well that ends well

Mary Krinkie, vice president of government relations, Minnesota Hospital Association 

Like many of William Shakespeare’s plays, All’s Well That Ends Well is a story with complex characters that betray, seduce, and outmaneuver each other. It is a story with many twists and turns that makes its audience unsure of how the play will end. The 2015 Legislative Session had a lot of predetermined conflict with a newly-elected Republican Speaker Kurt Daudt, smart and articulate, but not as sure footed as his counterpart, DFL Senate Majority Leader Tom Bakk. Combined  with DFL Governor Mark Dayton, who has repeatedly stated that this is his last time serving in public office and that he is “freed up” to do what he thinks is best for Minnesota. The twists and turns of this year’s budget process had Health and Human Services stakeholders very anxious about the future of state health care spending. The Senate and House HHS budget bills had very little in common and their spending targets were in sharp contrast, with the Senate bill spending $341 million above current forecasted spending and the House bill cutting more than $1.1 billion from projected spending. Despite these differences, legislators found a way to compromise and construct a Health and Human Services budget bill (SF 1458/HF 1638, Chapter 71) that includes many provisions of priority for the Minnesota Hospital Association. So, from a health care perspective, all's well that ends well.  

Highlights from the 2015 Session include: 

  • Keeping the MinnesotaCare program as a Basic Health Plan. MHA supported the Senate position of keeping MinnesotaCare as the coverage option for low income working Minnesotans. This aligned with our long-standing, bedrock value of ensuring affordable access to quality health care for all Minnesotans. Given that the federal financial participation for the MinnesotaCare program has been less than what was originally anticipated it would be, MHA also supports the new statute language creating a Task Force on Health Care Financing that will look at options for MNsure and coverage alternatives for this population.      
  • Expanding access to mental health services. Throughout the session, MHA partnered with the Minnesota chapter of National Alliance on Mental Illness (NAMI-MN) in building support for increased funding for programs to address the urgent need for greater access to mental and behavioral health services throughout the state. MHA is grateful legislators from both the Senate and House responded positively to this outreach, providing more than $38 million in new state spending; which will support crises teams, psychiatric residential treatment facilities, behavioral health homes and some initial funding for protective transportation. In addition, $2 million was allocated to hospitals that provide inpatient mental health services to compensate for rate reductions associated with the rebasing process. This funding will leverage federal matching dollars.    
  • Improving access to care via telemedicine. MHA is very pleased our Telemedicine Act is included in the final HHS bill. Health plans will be required to pay for services on the same basis and at the same rate regardless of whether they are delivered via telemedicine or on an in-person basis. The Medical Assistance program will also be required to cover an expanded list of providers who are now allowed to bill for services provided via telemedicine. Telemedicine will allow people, especially those in rural communities, to have greater access to care and specialty services, like mental health and avoid unnecessary travel time and expenses. Unfortunately, the provision requiring an originating site fee for health care providers was deleted from the bill.   
  • Sustaining our rural hospitals and hospital rebasing language. MHA’s highest finance priority was to advocate for new funding for the Critical Access Hospitals (CAHs) and to advance a new distribution formula for Disproportionate Share Hospital (DSH) payments. MHA is very pleased that both of these provisions are included in the final HHS bill.   
    • $5.096 million in new state funding will leverage federal matching funds and is allocated to Minnesota’s 79 Critical Access Hospitals, bringing all CAHs up to either 85 percent, 90 percent or 100 percent of their costs. CAHs often serve a large number of senior citizens and low income individuals, enrolled in Medicare and Medicaid. Both of these programs reimburse hospitals at rates that are below the actual costs of care. MHA strongly supported this provision to help maintain access to life-saving care for residents in rural communities.   
    • The HHS bill includes language supported by MHA extending the +/-5 percent payment bands that were put in place in response to the budget neutral rebasing process. This language provides some additional time for hospitals to adjust to a potentially large swing in their current Medical Assistance payment rates. In addition, a new distribution formula for Disproportionate Share Hospital (DSH) payments targets funding for children’s hospitals, psychiatric DHS-contracted inpatient services, transplants and high volume Medical Assistance providers.   
  • Working to foster hospitals as places of safety and healing for patients, visitors and health care workers. MHA is part of a coalition that came together to create and share best practices for preventing and responding to violence in health care settings. The HHS bill includes language mandating that hospitals have violence prevention plans in place by Jan. 15, 2016 and violence prevention training for all direct health care workers. MHA supported this position with the caveat that there would be no additional data reporting requirements imposed on hospitals.   
  • Investing in workforce development. MHA is pleased the HHS bill includes several new investments in workforce development. New funding includes:  $2 million added to the current MERC formula, $5.262 million for loan forgiveness, $2 million for international medical graduate residency slots, $3 million for new primary care physician residency slots and $2 million for home and community based services workforce scholarships. In addition, legislators also passed SF 253/HF 321, the Interstate Medical Licensure Compact, which will streamline the process for physicians seeking to practice in more than one state.   
  • Adding hospitals to current protective language regarding Medical Cannabis. With advocacy efforts from several hospital systems, SF 1792/HF 1471 was amended to add hospitals to statute language that is already in place for nursing facilities, providing some protection for hospitals when medical cannabis is brought into the facility. The language also extends some state protections to our employees who may need to handle or store medical cannabis on behalf of a patient. 

Thank you for the continued support and grassroots advocacy MHA members receive from their trustees. While the information above highlights just some of the good work of the 2015 session, it is important to note that much of this new funding relied upon using $455 million from the Health Care Access Fund (HCAF). This will impact future discussions on the role of the HCAF and what uses are considered “acceptable” and “not acceptable.” The 2016 session will be fast-paced and hectic with a delayed start date of March 8 and a strong desire to complete unfinished work on a Tax Bill and a Transportation Bill. 

Please reach out to your local legislators and thank them for their public service and for working hard to resolve key health care issues in such a positive manner! Return to top    

Koranne joins MHA leadership team

Rahul Koranne, MD, MBA, FACP, joined the Minnesota Hospital Association as senior vice president for clinical affairs and chief medical officer this past January. Dr. Koranne is board certified in Internal Medicine and Geriatrics. He most recently served as vice president and executive medical director at HealthEast Care System, with responsibilities for Bethesda Hospital and Community Services. Prior to joining HealthEast, he practiced medicine in Starbuck, MN, providing primary care in a rural critical access hospital for five years.  

In addition to his clinical work and physician executive experience, Dr. Koranne has been very active in health policy circles in Minnesota, serving on a wide variety of state work groups, boards and commissions.   

“His experience and passion for transforming care delivery to meet the Triple Aim throughout Minnesota make him a great fit for our new position,” said Lawrence Massa, MHA president and CEO. 

“After being involved with the AHA Regional Policy Board and MHA Physician Leadership Council for the past many years, it is an honor and a privilege for me to join MHA in this new capacity and work with our member hospitals and health systems to discover new models of health for communities across MN,” said Koranne. “Minnesota hospitals and health systems have consistently been at the cutting edge of innovation and have helped set the national standard for how health care should be delivered to our communities — relying upon multidisciplinary teamwork, community engagement and a spirit of authentic partnering between various organizations across industries and sectors. As health care reform continues to unfold, there will be challenges ahead which are sure to lead us to opportunities to collectively redefine the system of health and create positive change for those whom we are privileged to serve — our patients, their families, communities and health care staff.” 

The senior vice president for clinical affairs  and chief medical officer position was created to provide greater value to the MHA membership by helping members develop stronger physician leadership, achieve higher levels of integration of care, clinical performance, operational efficiency, patient safety, patient satisfaction, and population health. Return to top     

Mary Theurer honored as MHA Trustee of the Year

The MHA Trustee of the Year award honors a hospital leader who has contributed significantly to the health of the community by providing leadership and guidance to the hospital or health system board. The 2015 Trustee of the Year is Mary Theurer from Lakewood Health System in Staples, where she serves as chair of Lakewood’s district board and as secretary of Lakewood Health System’s governing board.   

Mary does an exemplary job focusing on appropriate oversight and continuity between the two boards. She represents the board on numerous committees and councils and is a certified trustee. Recently, after attending an MHA event where she learned about the importance of patient and family engagement, Mary encouraged the hospital to develop a Patient and Family Advisory Council, which the hospital is proudly developing.   

Mary is a community and civic leader, often bridging the gap that can occur between various organizations and agencies. She is detail oriented and holds others accountable to high standards of conduct, training and excellence in the hospital board room, council chamber, and in her personal life. Mary’s direction and leadership have helped sustain Lakewood Health System as a strong regional health care leader to ensure it can continue to serve and respond to the needs of its patients and community. Return to top     

Fact sheets on MHA federal policy priorities

MHA members and staff met with the Minnesota congressional delegation as part of the American Hospital Association’s Annual Meeting in May. At these meetings, MHA shared fact sheets to discuss with the delegation the important issues impacting Minnesota’s hospitals and health systems and outline specific action requests.   

The fact sheets also highlight the ongoing efforts of Minnesota hospitals and health systems to continue advancing the high quality, low cost care for which we are nationally recognized.      

Click the links below to view the federal fact sheets: 

For more information, contact Ann Gibson, MHA vice president of federal relations and work force, at 651-603-3527. Return to top     

Minnesota hospitals’ board members embrace certification

Since its inception in January 2008, interest in the MHA board certification program has steadily grown. Currently, more than 500 board members from Minnesota hospitals are actively working toward certification. There are 107 board members that have already been certified.   

The following board members were recognized for completing the certification process at the MHA 2015 January Trustee Conference: 

  • Alvin Alm, Community Memorial Hospital, Cloquet 
  • Stanley R. Bandur, Ridgeview Medical Center, Waconia 
  • Roger W. Hanson, United Hospital District, Blue Earth 
  • Melanie Humburg, United Hospital District, Blue Earth 
  • Glen Lindseth, Sanford Bemidji Medical Center 
  • Larry Lundblad, Lakewood Health System, Staples 
  • Bruce Meade, Sanford Bemidji Medical Center 
  • William I. Mennis, M.D., Lakewood Health System, Staples 
  • Allen R. Molascon, Hendricks Community Hospital Association 
  • LaVerne Moltzan, Essentia Health St. Mary's Hospital-Detroit Lakes 
  • Julie Olson, District One Hospital, Faribault 
  • Eric L. Pederson, Cook Hospital & C&NC 
  • Brian Samuelson, Swift County-Benson Hospital 
  • Dean Thompson, Sanford Bemidji Medical Center 
  • Steven Vopat, M.D., Community Memorial Hospital, Cloquet 
  • Susan Westrom, RiverView Health, Crookston 

Another 22 trustees have recently completed certification requirements and will be recognized for their work at the Summer Trustee Conference in July.   

The MHA Trustee Council developed the voluntary board certification program as way to verify a trustee's initiatives to improve personal health care knowledge, leadership effectiveness and compliance with a variety of governance best practices. Certification is a viable way of assuring various stakeholders that Minnesota hospitals hold themselves to high standards and are accountable for their governing performance.   

If you are currently working toward certification, watch for an email early next week with a personalized link for checking your credit totals at any time.   

For those interested in becoming certified, information can be found here or on the trustee section of the MHA website under “Board Certification.” Return to top     

MHA Trustee Council develops advanced certification program

The MHA Trustee Council has developed the next step in advancing trustee certification. This new advanced program offers trustees who have completed their MHA certification, education guidance to ensure excellence, innovation and accountability in health care governance. Staying informed on the pressing governance issues and advancing governance best practices will provide trustees with continued background and quality education needed to show stakeholders that high standards and accountability are central to successful governance.   

Board members who have completed the MHA Trustee Certification Program are eligible for enrolling in the Advanced Certification Program. To participate, you must complete the Advanced Enrollment Form and receive approval from MHA. A total of eight credits are needed to complete the Advanced Certification. Two credits are needed in each of the following categories: Effective Governance, Strategic Planning, Quality and Patient Safety, and Board Development. The eight credits can only be received by attending MHA education programs. Advanced education programs will be provided at both the January and July Trustee Conferences.  

Information about the program can be found here or on the trustee section of the MHA website under “Board Certification.” Return to top     

EHR ROI: Meaningful use and leveraging your electronic health record

Shira Hauschen, Dorsey Health Strategies LLC, a consulting firm affiliated with Dorsey & Whitney LLP, Minneapolis  
Meaningful Use (MU) is again at the forefront of many hospital leaders’ minds, as the Centers for Medicare and Medicaid Services (CMS) released a proposed rule in early April that aligns Stage 1 and Stage 2 incentives and sets out guidelines for the third and final stage of the MU program. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 established significant financial incentives for eligible hospitals and providers to use a certified electronic health record (EHR) in a “meaningful” way. Many Minnesota hospitals and health care providers were already ahead of the game as they worked to comply with state legislation enacted two years prior (Minn. Stat. §62J.495) that required implementing an interoperable EHR by Jan. 1, 2015. Spurred by both this statutory requirement and federal MU incentives, EHRs now prevail in Minnesota hospitals and health care provider settings. The question becomes: how to leverage those EHRs to meet meaningful use objectives?     

Whether you are planning for Stage 1 or Stage 3, the following tactics may help ensure success: 

  • As you launch your MU program and throughout implementation, frame — and continually re-frame — your discussions about meaningful use within the broader context of improving patient care. If you focus solely on measuring MU objectives, you may miss opportunities to implement strategic change. For example, while creating a dashboard that monitors only MU-related objectives is important in and of itself, the dashboard design process can also prompt discussion about additional helpful metrics or other ways of delivering care. Too much scope creep will stymy your MU planning process, but do allow for some breathing room in MU discussions to imagine new possibilities.   
  • Muster and equip an integrated team for best results. Too often, MU data report design and collection is helmed by a team of IT and EHR technical experts, with a few clinicians sprinkled in. Designate a hospital leader from your strategy and/or business development units as a team member, potentially as the lead. Include a physician champion and nurse champion at the outset.  
  • It will be critical to mirror clinicians’ workflows in designing the MU dashboard and data reporting tools. Aligning your MU tools with clinicians’ mental maps — when and where they input each data element — is critical for success. You likely mapped clinical workflows when you were designing your EHR; dig those maps out and check where providers document each MU objective data element (e.g., where do they add a medication or allergy?). If you design with those answers in mind, you will create a set of MU tools that clinicians actually use.   
  • To promote buy-in, communicate less about the strategic importance of MU and more about exactly who should be inputting what. If this sounds less than inspirational, consider that most clinicians will quickly grasp and support your organization’s desire to achieve MU incentive payments. Clinicians’ time is limited and most wish to help, so their well-intentioned response is, “Just tell me what to do and where to click.”  Communicating specifically and often about where to click will cause your Meaningful Use adherence to skyrocket.   
  • Address underlying cultural change issues. Providers’ belief in the power of data is now fairly widespread, however, daily use of it is not — yet. Engage your providers face-to-face, whether in town hall meetings or via roadshows visiting multiple sites. Be sure to share and provide access to the MU dashboard early, even in beta form, to encourage feedback, fine-tuning, and early adoption.   
  • Leverage MU-specific resources unabashedly. Convene your EHR vendor’s technical support together with your MU team and identify tools or minor coding modifications that might ease your data collection efforts. Meet with other providers who are in a similar place in their MU programs to share ideas or even the costs of technical solutions (particularly if you have the same EHR software). 

Contact Shira Hauschen at Dorsey Health Strategies at 612-492-6418 for more information. Return to top     

Losing control? How a strategic roadmap can help you get it back

Perry Hanson, MHA, director of health care organizational consulting, Eide Bailly LLP, Minneapolis Feeling a little lost? As I talk to CEOs and other C-suite executives at hospitals and health systems, the amount of stress and uncertainty they’re facing is almost overwhelming. Health care reform is real and pervasive country-wide; health systems boards and C-suite executives often feel as if they’re driving without a map. With so much change coming so quickly, and with major shifts in the reimbursement principles/practices and operating culture of health care, it’s no small wonder that leaders are turning to a formal strategic planning process to try to chart a more sustainable course.   

But the old strategic plan where you decide what your five-year goals are and then revisit the document once a year will no longer work. Today’s strategic plans are living, breathing documents that provide real-time navigation with quarterly tactical adjustments. In order to chart new territory, you need to ask new questions. The foremost is: where do you want to end up? The second is: how do you want/need to experience the journey?   

For most organizations, their first priority is to navigate health care reform. The second is to remain the relevant and thriving provider in their market. The underlying assumption is that to exist at all they need two things: patients and providers. Health care reform is mandating forced change, but innovative hospital and health system leaders are seeing this as an opportunity to shed outdated methodologies and delivery practices, and to adopt a new ways of being—where wellness, not illness, drives the business of health care.   

Now, I could talk a lot about what the implications of health care reform will be. But let’s get back to strategic planning, because planning is how you make sense of the chaos. Here are four things that you, as a leader in a hospital or health system, can do to create a roadmap to the future:

  1. Get clear on who your customer is. Historically, physicians have been the primary customer of the hospital. The hospital has been in the position of helping physicians care for their patients. Today, the patient is the customer of the hospital. The hospital and physicians need to work together to deliver a coordinated episode of care to return the patient to a desired/achievable health status.
  2. Be complete in your strategic planning. This means you need to see it as an ongoing process, not a one-time event. You need leaders aligned around the value and importance of the strategic plan, and need to include more than just financial or marketing professionals. It is a comprehensive plan that centers around the patient and encompasses organizational goals, operations, culture/values and finance. You answer the questions who you are, where you have been, where you’re going, and what the patient experience will be.
  3. Do a reality check. Your strategic plan outlines what the patient experience is supposed to be, and sets forth what your brand represents. But is that what you actually deliver? Is there alignment between who your organization says it is and how patients (and employees!) experience your organization? If not, you’ll need to create an alignment strategy. Little else will matter if your patients are not having a positive “patient-as-customer” experience. 
  4. Create a physician compact. A compact is a negotiated agreement between two parties that essentially says “I’ll give you this in return for that.” It establishes fair trade value and creates a commitment between the parties that ensures everyone knows what their role is, why they matter, how their value is compensated, and what they need to do to contribute to the shared goals. In this case, the primary goal is to deliver an aligned patient care delivery experience that backs up who your brand says you are. Without your medical staff colleagues on board, you’ll be hard pressed to achieve strategic goals around care coordination.   

Strategic planning is a simple, yet highly effective way to create a roadmap that aligns everyone to agreed-upon goals. The process requires some investment of time and thinking, but in the end, it offers your organization the opportunity to take back control over your response to the industry’s transformation through your own dynamic, continuous and market-focused effort.   

For more information, contact Perry Hanson at 612-253-6697. Return to top     

Effective long-term capital planning for small and rural hospitals

Tanya K. Hahn, managing director and head of health care public finance, and Paul Donna, managing director, Minnesota Public Finance Office, Robert W. Baird & Co., Mahtomedi  
Many small and rural community hospitals wrestle with how to manage construction and renovation projects that need to be completed to best serve patients. Backlogs of deferred maintenance items — some of which may be unknown — can further complicate planning. Ongoing discussions about how to add, renovate or replace emergency departments and rehabilitation spaces, upgrade patient rooms for more privacy, and expand service lines can feel next to impossible in the current economic climate. Adding to the challenge is the impact of managed care on patient utilization, low reimbursements, demand that is high for some service lines but declining in others, fierce competition and stretched capital dollars. However, there are several important steps hospitals can and should take to plan for long-term financial solvency.   

Create a capital improvement plan and prioritize needs
The first step is to create a capital improvement plan that assesses every long-term fixed asset residing on the organization’s balance sheet. This should include a walk-through with your facilities team and review of your fixed asset schedules to determine the status of key items.   

Every item on the plan should have a specific target date and cost estimate for replacement. Items often overlooked include assets such as parking lots, landscaping, interior streets, signage, bathroom facilities and internal decorations, such as art for common seating areas. You will then need to prioritize needs based on factors such as safety and security, organizational mission support, energy and cost savings, revenue generation, expansion of consumer base or maintenance of market share, and asset failure or damage costs.   

Determine available capital
Capital is generated from multiple sources including annual excess operating cash, funded reserves, capital campaign dollars, contributions, leases, asset sales and the issuance of debt. Rarely is the scale balanced as illustrated due to competing capital needs mentioned previously and not enough sources to match the needs. However, at a minimum, targeting annual depreciation expense as a funding level for expenditures is a basic guide and implies a hospital is at least reinvesting and keeping up with depreciation, a noncash expense, every year.   

Establish a debt and capital funding policy
Hospitals should create a debt and capital funding policy to identify what projects are funded from operating cash flow, fundraising contributions, capital campaigns, leases and debt. Funds can be easy to raise for special projects like pediatric wings, women’s health centers and specific equipment needs. However, donations to fundraising campaigns are usually paid over time. Organizations need to set a percentage of gifts received in cash before starting projects and fund for future operating expenses related to any building project so assets can be self-sustaining in the future, helping to lower the burden on the hospital’s operating revenue.   

Additionally, funding projects from operating cash needs to be tied to the time period over which the capital will be funded. If a project is just one year in duration, then look to one year’s worth of operating cash and if more than one year, use the sum of the two or three year time period as your base.   

Debt-funded projects may be identified as those which are revenue self-supporting if possible, and projects that can be completed in approximately 36 months, due to IRS limitations on spending tax exempt bond proceeds. Organizations should plan to put some amount of equity into the project even if planning to fund with debt given the current lending environment, and particularly if utilizing tax exempt private placement debt. Putting equity into the project also lowers the amount of leverage the organization incurs, lessening the pressure on the income statement results each year.   

In closing, if all of the above items are considered when planning capital expenditures, small and rural hospitals can be confident they have been thorough in making capital funding decisions and securing a solid capital position overall for their organization. This diligence will ensure a more financially-solvent organization for the long-term regardless of what external factors may be impacting the hospital’s operations.   

Robert W. Baird & Co. is an international financial services firm that provides investment banking, debt financing, and capital planning services to nonprofit hospitals, senior living providers and other nonprofit organizations. For more information, contact Tanya Hahn at 614-629-6951 or Paul Donna at 651-426-8533. Return to top    

Boards can optimize an organization’s performance by focusing on Triple Aim

Jennifer Lundblad, president and CEO, Stratis Health, Bloomington  
When it comes to tackling big issues facing health care organizations today, governing boards are more productive, thoughtful, and sophisticated in working with leaders than even a decade ago. That is especially true as it relates to work toward the Triple Aim: 1) better care, 2) better health, and 3) lower cost.   

Organizations and their boards can impact quality and safety with a laser-sharp focus on the Triple Aim, introduced in 2008 by Dr. Don Berwick, by creating a framework for improving the experience of care, improving the health of populations, and reducing per capita costs of health care.   

Dr. Berwick was president of the Institute for Healthcare Improvement. His message was simple: Better care is about how health care is delivered, in patient-centered ways with ever improving quality through the best available evidence and research. Better health is focused on populations, illness prevention, and wellness. Lower cost is about reducing costs at the patient and family level, but also about reducing inefficiency and redundancy in the system.   

At Stratis Health, we have worked with organizations to use the Triple Aim, community health needs assessment information, and the IHI Framework for Leadership for Improvement categories as the “how to” for developing specific actions for governing boards around quality and safety:   

Establish the mission, vision and strategy
The board’s role is to set direction and monitor performance. This can include integrating strategy and quality, monitoring the culture of quality and safety, and establishing aims for safety and quality improvement.   

Sarah Urtel is the executive director of strategy and organizational effectiveness at Ridgeview Medical Center in Waconia. She says that Ridgeview’s board does a “deep dive” into the organization’s mission and vision every three years. “We review our mission to make sure it is on track with who we strive to be as an organization,” she said. “The mission shouldn’t change very often, but the vision is adjusted to continue to push us forward, continually raising the bar.”   

Build the foundation for an effective leadership system
The board must establish an interdisciplinary board quality committee and bring knowledgeable quality leaders onto the board. Set and achieve educational standards for the board members so there is a core knowledge base about quality among all board members. The board should build a culture of real, authentic conversations about improving care at board and committee meetings, with physician and nursing leaders, and with administration. 

“Our board is actively engaged and eager to be a part of this significant quality work, and especially in involving the medical staff,” explained Urtel. “Our chief of staff attends all board meetings and provides a medical staff update.”   

Stratis Health recently led a session for hospital board members to provide an orientation about the shift from volume to value in U.S. health care and the role of value-based purchasing. The presentation recommended five calls to action for trustees – know your numbers, set the bar high, support a learning culture, build community partners and stay current. Trustees said they were better equipped to support their hospital’s success in a value-driven health care environment.   

Build will
To build the will to take action, the board needs to establish a policy of full transparency about data on quality and safety. As part of achieving transparency, the board should insist on the review of both data and stories from patients and families, and help patients and families tell their stories directly to staff, senior leaders, and the board. There is nothing more compelling to build will than patient stories. 

The board should establish policies and practices with respect to errors and injuries that emphasize respectful practice, disclosure, apology, support, and resolution. Understand both the current performance of your hospital and the performance levels of the best hospitals in the world. Place quality first on the board agenda and devote at least a quarter of the board’s agenda to it.   

To that end, the Northfield Hospital board of directors invited Stratis Health leaders to its meeting to provide an understanding of the hospital quality landscape nationally and in Minnesota, and to share specifically some of our data and observations about Northfield Hospital from their involvement in quality improvement initiatives. The dialogue enhanced understanding and stimulated engagement about quality and safety, and helped them understand their roles and responsibilities.   

Ensure access to ideas
Boards must ask management questions designed to generate ideas when reviewing progress against quality and safety aims: 

  • Who is the best in the world at this and have you talked to them? 
  • What new ideas have you tried and have you asked patients/families and front line staff for ideas? 

Attend relentlessly to execution
Establish executive accountability for achievement of aims, and establish an effective oversight process, including monitoring your system-level measures for improvement. Reviewing data generated on a regular basis. Ask hard questions, including: Are we on track to achieve the aim? If not, why not? What is the improvement strategy?   

“Our board asks very thoughtful and strategic questions about quality and safety at Ridgeview,” said Urtel. “We are fortunate to have board members so invested in our success and commitment to those we have the opportunity to serve in our communities.” 

Ridgeview created a “dashboard” of patient quality, experience and financial information that the board accesses through the organization’s Intranet.   

The most effective governing boards provide support to help the health care organization align its programs and services to its mission and strategy – and ensure that there are clear indicators for tracking progress for the highest possible quality and stringent safety.   

For more information on Stratis Health and its work with organizations, visit www.stratishealth.orgReturn to top    

Stop the bleeding

Dawn Lunde, vice president, Secure Bill Pay, Eagan  
Just over half of the population is aged 25-64, so there are two generations who grew up on first dollar insurance coverage with the perception that health care is free. Today, 80 percent of commercially insured patients are on a high deductible health plan (HDHP) with an average deductible of $1,500 for an individual and $3,000 for a family, in addition to insurance premiums averaging $371/month for single coverage and $835/month for families [Sources: Kaiser Family Foundation and American Health Insurance Plans]. This shift in financial responsibility began about ten years ago with the introduction of medical savings accounts and the now ubiquitous health savings accounts (HSAs). So, if a growing portion of the bottom line should be coming from ill-prepared patients, what can a hospital do to stop the bleeding of their revenue cycle?   

Create the right culture: Payment is expected
At what point is payment typically discussed with patients? If it is any time after initial registration or appointment scheduling, then it’s too late. The likelihood of patients paying the full amount owed drops by 50 percent the minute they walk out of the facility. When initially engaging with patients, share your expectations with them. This can be done in a very positive manner and patients will appreciate feeling informed and being presented with patient payment options (credit, debit or HSA card, check or bank account, cash, and even recurring payment plans or payment account-on-file, if you choose). The best part is that they are much more likely to pay.   

Make it easy to pay
There are countless points of contact that patients have with the hospital. Be sure to allow all forms of payment (cash, cards, checks, bank account) in all settings and give access to the right tools to all applicable staff: 

  • Secure card (or bank account) on-file: obtain this information in a secure online form (patients complete prior to service) or at the point-of-service, then debit that account as soon as you know what the patient owes. 
  • Point-of-service: all locations, whether via a check-in or check-out process. Patient self check-in kiosks have proven to boost collection rates by 40 percent. 
  • Online: 41 percent of all online bill payments in Secure Bill Pay are after-hours. In fact, nearly 20 percent of those are from a mobile device! Be sure they can easily find the “Pay Online” link on your website. And, if your online bill pay site does not require a login, you will obtain much higher adoption rate. 
  • Phone: accept and process eChecks and cards real-time via phone calls to your business office for patients who cannot pay online. 
  • Mail: make it very easy for a patient to mail a check to you. 
  • Scheduled payments: either pre- or post-service, allow patients to pay via a payment plan or a one-time scheduled payment. Allow patients to request the payment plan online, via phone and/or at the point-of-service. These are approved by appropriate staff and run automatically without further effort. 

After several years of providing patient pay tools to clients ranging from critical access hospitals to large health systems, Secure Bill Pay has observed that organizations who implement these strategies see annual double-digit increases to their patient pay revenue. Is your patient pay process fast and easy? With these strategies and the right tools, it can be.

For more information contact Dawn Lunde at 866-610-9601 ext. 102. Return to top