BayCare Health System this week opened a new $225 million hospital in suburban Lutz, just north of Tampa. St. Joseph's North is the first full-service hospital built in the Tampa Bay area in more than 30 years.
The 350,000-square-foot, three-story hospital features 108 private beds, 32 of which are for outpatient observation, and 76 of which are for inpatient care. The "all-digital" hospital offers emergency care, surgical services, imaging and diagnostic facilities, ICU, and a family-centered environment.
The full-service Emergency Department at St. Joseph's Hospital-North includes 30 private rooms for adult and pediatric patients. A fast-track area expedites treatment for minor emergencies.
Many of the private suites include large HDTVs, full bathrooms, and accommodations for an overnight guest. Room service provides made-to-order meals.
"Our family-centered care philosophy allows relatives and visitors to be collaborators in patient care," said Paula McGuiness, COO for St. Joseph's Hospital-North. "By incorporating the family, everyone is working together to meet the needs of the patient."
Evidence-based design include an identical floor plan to improve efficiency; workflow designs to ensure that medication, supplies, and meals deliveries keep caregivers close to patients; and noise reduction features, such as carpeted hallways, noise-absorbing tiles and glass sound barriers.
St. Joseph's North is LEED-registered by the U.S. Green Building Council, and the building is designed to achieve green building certification. The building is made of materials that support energy conservation and clean air with low chemical emissions and recycled content.
Austin, TX-based St. David's HealthCare announced today that it will acquire the 58-bed Heart Hospital of Austin from MedCath Corp.
Financial terms of the deal were not disclosed.
"This facility acquisition will complement the already exceptional cardiovascular programs currently operating throughout St. David's HealthCare," said Jon M. Foster, president/CEO of St. David's HealthCare, in a media release. "One of the clinical areas St. David's HealthCare has continued to develop regionally is our cardiovascular service, which is strong thanks to the outstanding care provided by our St. David's HealthCare-affiliated physicians and staff."
The acquisition will be finalized after the regulatory approval process.
St. David's HealthCare operates seven hospitals in the Austin area, and MedCath is a 10-hospital health system based in Charlotte, NC.
The Jan. 12 earthquake that flattened much of Port au Prince, Haiti, and killed at least 230,000 people is providing valuable lessons for disaster preparedness and response on an almost unimaginable scale, says Scripps Health CEO/President Chris Van Gorder.
"There were two reasons why we went down there," says Van Gorder, who recently returned from his second trip to the stricken nation since the earthquake. "The first was humanitarian. The second was the learning. I am passionate about disaster planning and I don't believe the time to learn how to function in a disaster is when the disaster occurs."
Van Gorder concedes that it's doubtful that the United States will experience a natural disaster of similar magnitude because of building codes, infrastructure, engineering, and planning. The Haitian earthquake and the 1989 earthquake that struck the San Francisco Bay area both measured around 7.0 on the Richter Scale. The San Francisco quake claimed 63 lives. Even Hurricane Katrina, with more than 1,800 fatalities, pales in comparison to the death toll in Haiti.
Regardless, Van Gorder says providing care in the most challenging of environments is giving U.S. healthcare professionals valuable experience that can't be replicated by disaster training drills.
"We saw the injuries that would occur in an earthquake—major extremity injuries, major crush injuries, amputations, spinal cord injuries, pressure ulcers caused by people being underground and in the same position for extended periods of time," Van Gorder says.
The Scripps response team and a University of Maryland medical team worked in the remains of the Hospital St. Francois de Sales. It was grim, desperate work under bad conditions.
"Half the hospital collapsed, a four-story building which was their pediatric unit. The estimate was somewhere between 50 and 200 bodies were still entombed in the building," Van Gorder says. "We went into some areas of the hospital that hadn't collapsed, but were adjacent to the building and the smell was atrocious. Our CMO said he almost threw up, and he has been dealing with trauma his entire career."
Even in those hellish conditions, Van Gorder says he was inspired by the extraordinary flexibility and creativity of doctors and nurses.
"They created as sterile an environment as possible without the tools we have here. Our scrub sink was a bucket outside. We saw a rip saw that was being sterilized for amputations. Fortunately we didn't have to use it."
"We were doing our anesthesia on the first trip with ketamine. There was no general anesthesia. There was no intubating the patients during surgery," he says. "A nurse anesthetist gave them a shot and disappeared. I was responsible for monitoring the patients' vitals while the surgeon did surgery and I was a scrub nurse. It wasn't Civil War medicine, but it was more like World War I medicine."
When the Scripps team returned to Haiti with more medical supplies, Van Gorder says they could administer pain medications and general anesthesia.
"Instead of going directly to amputations, we were trying to save limbs," he says. "But we had one woman who died of pneumonia and congestive heart failure. There was no technology there to save her. She died outside under a tent. It was the best we could do under the circumstances."
Van Gorder says the road to recovery for Haiti will be long. Non-governmental organizations that are trying to provide care and other assistance must understand that the Haitian government has essentially ceased to exist.
"The Health Ministry completely collapsed with many of the leaders of healthcare in Haiti killed within the building. The Supreme Court was killed in session. The palace has been destroyed," Van Gorder says.
"The question is what happens from here? It's a poor country that imports everything and exports little if anything. They had a hard time feeding and educating their population before this. Look at the destruction, both in the public and private infrastructure, and you wonder where the money is going to come from to rebuild. I often wonder how long countries and hospitals will have the appetite to continue to work in Haiti. It's not month, we are talking years before they can recover."
The White House hinted that President Obama might post his own health reform bill on the Internet before the bipartisan healthcare summit he is planning for next week, the New York Times reports. Obama has announced the health summit to try breathe life back into the legislation and has promised to put the Democrats' bill online before the session. During a news conference, President Obama said he envisioned posting a merged House-Senate bill that would address his goals of controlling costs and expanding coverage, the Times reports.
An early morning fight at a roadhouse on Presidents Day spilled into the emergency department at Scotland Memorial Hospital in Laurinburg, NC, and ended in a shooting that left a patient in critical condition, his alleged assailant in jail, and the hospital in lockdown.
Scotland Memorial officials issued a statement detailing the 3 a.m. shooting on Monday morning, which remains under investigation by Laurinburg police.
"An individual, stating he was a patient's brother, asked to be let into the Emergency Center to visit his brother. The patient was being treated for a facial laceration that he stated he received as an innocent bystander of a fight that broke out between others. He essentially told the police the same story," the hospital statement read.
"The suspected shooter, upon entering into the patient's room shot him several times and then left the room, wandering around the Emergency Center, looking for an exit, finally exiting from the X-ray area."
"The Scotland Memorial Hospital Emergency Center staff initially took cover, then immediately called 911 and the nursing supervisor once the suspect left their area. The supervisor called the hospital units, alerting them—all units secured themselves and their patients. EC staff quickly returned to their patient care duties, including caring for the injured patient and later, the suspect himself. Local law enforcement responded quickly and captured the suspect on the hospital grounds," the statement read.
The hospital was put into lockdown for several hours following the incident. No visitors were allowed in or out of the facility until 7 a.m., but security staff used wands to check Emergency Center visitors, according to Scotland Memorial.
Scotland Memorial CEO/President Greg Wood said that the wounded patient suffered critical injuries, and has been removed from the hospital.
"We have never experienced anything like this in our hospital before," Wood said in a media release. "The safety of our patients, visitors, and staff is of paramount importance to us and we have extensive security measures in place to minimize the likelihood of such a horrific incident as this. Staff is receiving stress debriefing and we will conduct a thorough review of our policies to see how to strengthen our security even more. Our staff responded with the professionalism expected of them, ensuring that their co-workers and the other patients were unharmed."
Calls to the Laurinburg Police Department were not immediately returned. However, The Fayetteville (NC) Observer reported that police identified the shooting victim as Domario Covington, and that he suffered multiple gunshot wounds to the chest. The alleged gunman was identified as Wayne "Wolf" Simmons, 49. Police told the newspaper the shooting stemmed from an incident at a nightclub in nearby McColl, SC.
The call by Florida's private health insurance plans to expand Medicaid managed care while eliminating fee-for-service programs and the state's MediPass program is meeting resistance from healthcare providers.
"We don't think that the single approach that the health plans put forward is the one thing that Florida should do," says Bruce J. Rueben, president of the Florida Hospital Association. "Rather, there should be multiple numbers of approaches that are more directly suited to the population centers and the communities that need to be served."
Rueben says HMOs don't work well in rural areas with sparse populations and few services. "In urban areas, there are enough primary care doctors and specialists, there is the full continuum of care from acute-care services through emergency care services all the way through long-term care," he says.
Florida is staring at an estimated $3 billion shortfall for fiscal 2010-2011. State lawmakers have asked healthcare stakeholders for ideas to contain runaway costs for the $17.9 billion Medicaid program, the fourth-largest Medicaid program in the nation, which grew by 11% last year and consumes about 26% of the state's budget.
There were 17 Medicaid HMOs operating in 35 Florida counties last year. Thirty-one counties had no HMOs, and 27 counties had no managed care presence. More than 1.1 million of Florida Medicaid's 2.7 million eligible beneficiaries are now in HMOs. About 35% of beneficiaries are in fee-for-service programs, and 17% of beneficiaries, are in the Medipass primary care case management program, according to the state Agency for Health Care Administration.
Michael W. Garner, president/CEO of the Florida Association of Health Plans, Inc., says that transitioning the remaining beneficiaries into managed care plans could save $111 million over the next two years.
"We have been arguing that we need to move away from fee-for-service to a managed care system, much like a large employer will bring in an administrator to take over the management of their healthcare insurance and/or purchase insurance and transfer the risk to someone," Garner says. "We say give it to the health plans that are experts in managing risk and let us deal with it."
"We believe we bring improved access. We believe we can demonstrate quality and accountability better, and cost savings. We believe we are an effective mechanism for helping to control potential fraud and abuse in the Medicaid program," he says.
Jeff Scott, general counsel for the Florida Medical Association, says the health plans want the state to reduce provider payments by 10% to those who won't switch to managed care.
"Obviously, they want to eliminate fee-for-service because they want the entire Medicaid market to themselves," Scott says. "If you look at their proposal, what they've asked for is that in areas where they have a hard time negotiating a price that would allow them to make money off of being the Medicaid provider, they want the state to intervene and tell the hospitals and providers to negotiate in good faith."
Scott adds that insurers' definition of "good faith" is the HMO demanding reduced reimbursements without much provider input and the state going along with the cuts.
"That is the antithesis of a free market system. It's bizarre how they can make that recommendation with a straight face," says Scott.
Rueben says that—rather than giving tax dollars to out-of-state insurance companies—the state should continue to support local provider service networks that he says are cost-effective, and popular with beneficiaries.
"If you can do it here in Florida and keep those dollars in Florida, it is better than doing this for commercial HMOs that take their profits out of Florida," Rueben says. "Hospitals and doctors have made a commitment to live and work in Florida and serve Florida patients. These HMOs, if the picture is less than rosy, they're out of here."
Garner says the kind of Medicaid savings needed to help resolve the budget crisis can only be generated by eliminating fee-for-service payments. "The core of the problem is the way the fee-for-service system functions, which is to reward payment for utilization. The more you use the more you get paid," he says.
More than half of neurosurgeons in a national survey say they will cut services and time spent with Medicare patients if Congress doesn't act to permanently fix the sustainable growth rate formula, and prevent the 21.5% reimbursement cuts that are scheduled to go into effect on March 1.
The online survey also found that nearly 40% of the of 678 neurosurgeons who responded said they would decrease the number of Medicare patients they see, and more than 18% said they would no longer take new Medicare patients.
"These results really do paint a bleak path we are going down. Many neurosurgeons in our survey indicated that if Medicare payments continue to decline, they would stop providing certain services, reduce staff, defer purchase of new medical equipment, reduce time spent with Medicare patients, and begin referring complex cases elsewhere," said Troy M. Tippett, MD, president of the American Association of Neurosurgical Surgeons, one of three neurosurgical associations that sponsored of the survey. "It is crucial that Congress pass legislation immediately to address the decline in Medicare payments so that we can alter this course."
Tippett said neurosurgeons do not support the annual temporary "doctor's fix" that will only make it more costly to repeal the SGR in the future.
The survey found that neurosurgeons have seen changes in Medicare that have made it less patient friendly in the past five years. Most notably:
It has gotten harder to refer patients to certain medical and surgical specialists (67.2%).
More physicians are referring Medicare patients with complex problems to other doctors (64.8%).
Medicare patients now have to travel further to get needed care (63.7%).
Neurosurgeons are reducing the number of Medicare patients in their practice because of low reimbursement (59.2%).
The average waiting time for a patient appointment is 24.1 days for new patients and 19.5 days for established patients.
Neurosurgeons who limit the number of Medicare appointment slots do so through the scheduling process (42%), by limiting the overall number of Medicare patients they treat (35%), or by selecting patients based on their geographic location (10%).
Survey results also show that not all U.S. geographic locations are alike. Medicare patients in the Southwest face more difficulties in finding neurosurgeons. When compared to the national average, the Northwest and Northeast quadrants appear to be a bit more stable.
The survey was conducted by Perception Solutions in September, and has a 5% margin of error. The survey was sponsored by the AANS, the Congress of Neurological Surgeons, and the Council of State Neurosurgical Societies, which combined represent about 7,600 neurosurgeons.
The last two years of deep recession have forced many executives in the healthcare sector to take drastic steps to curb costs. Even though healthcare is one of the few sectors in the overall economy to see job growth, hospitals have not been immune to layoffs and other staff reductions.
While the job cuts may have an immediate effect on cost containment, other downstream costs should be considered.
The new HealthLeaders Media Industry Survey 2010 found that 38% of hospital CEOs and 46% of CFOs found layoffs and staff reductions to be an effective strategy when dealing with an economic crisis, while 37% and 35% of CEOs and CFOs, respectively, remained neutral about the idea. Only 25% of CEOs and 19% of CFOs found layoffs to be ineffective. [See Question 13.]
When C-suite denizens are asked in the survey to gauge the impact of healthcare trends on their hospitals in the next three years, their responses provide an interesting contrast. For example, 51% of CEOs say the nursing shortage will negatively impact their operations, and 53% say organized labor will negatively impact their organizations. [See Question 6.]
So, on the one hand, 75% or more of senior hospital executives either support or are neutral on the idea that layoffs are effective, while half of those same executives say they're apprehensive about workforce shortages and unions.
Here's the problem: Cutting staff–regardless of the motive–will save money short term, but it also will exacerbate future workforce shortages when it's time to start hiring again, and push remaining employees–fearful of job security–into the welcoming arms of organized labor.
Is there disconnect here?
Not entirely, but there is some static on the line.
To be fair, these executives in the survey aren't necessarily saying they're in favor of layoffs. They're saying that layoffs are an effective short-term strategy to deal with the worst economic crisis since the Great Depression. Many healthcare executives probably view layoffs as a regrettable last resort.
"I can't envision a scenario where a staff reduction is really an effective long-term strategy. It really falls much more closely along the lines of a short-term tactical response to a financial situation," says Bernie Becker, vice president/CHRO at Stormont-Vail HealthCare in Topeka, KS. "If you look at it strategically, unless you are eliminating programs and services and the people that are needed to deliver those programs and services, when business rebounds you are going to have to staff back up.
Most of the time, you are going to have higher labor costs than if you had left those people in place. It's always more expensive to hire people than it is to keep them." Chris Roederer, vice president of HR at Tampa General Hospital, concedes that layoffs are effective at containing costs. However, he says, hospitals that conduct layoffs risk losing long-term credibility with remaining employees.
"Many organizations that conduct layoffs feel the pain for years to come. Employees do not forget," he says. "With proper planning, organizations would be better served by meeting staffing reductions via attrition. That avoids the negative employee relations impact, potential negative impact on long-term recruitment, and severance and unemployment expense."
Lose employees' confidence and you also lose critical allies in the fight to identify and contain costs. "If employees trust and respect leadership, they will typically understand and even assist leadership in eliminating other expenses to avoid layoffs such as minimizing overtime, special pay practices, or modified shifts," Roederer says.
Once those employees are laid off, Becker says, there is very little chance that they will return, especially if they are skilled clinicians. "They are going to go somewhere where there is work. And, there is work. They may have to move, but we are dealing with a much more mobile workforce than we were 10 or 20 years ago. Our Gen X and Y folks don't have anywhere near the geographic restrictions that their predecessors did, and there is no sense of organizational loyalty. That is not in their blood. They think short term rather than long term anyway."
Becker recommends changing the cost-cutting focus from numbers of employees to payroll costs. "There is a bit of a knee-jerk reaction when an organization is faced with some serious financial obstacles that says ‘We have to let people go,'" he says. "Merely reducing head counts may not be the most effective or efficient way of achieving those targets. The organization is probably better served at looking at total payroll costs without necessarily letting people go. Maybe you examine some of your pay methodologies. Maybe you look at your overtime utilization, or your call pay utilization. Maybe look at benefit redesigns. There are ways to reduce the total labor costs without necessarily reducing head count."
The healthcare workforce shortage is not a threat to the future of healthcare delivery, because it's already upon us. It's not going to get better as our nation ages and requires more medical care and the people tasked with that care age along with us.
We often hear employers saying that "employees are our greatest asset." Why would anybody cut their greatest asset at a time of greatest need?
Note: You can sign up to receiveHealthLeaders Media HR, a free weekly e-newsletter that provides up-to-date information on effective HR strategies, recruitment and compensation, physician staffing, and ongoing organizational development.
State and national nurses associations are applauding a jury's quick verdict to acquit a Texas nurse of felony charges for reporting a physician to a state oversight board for allegedly providing unsafe patient care.
Anne Mitchell, RN, was charged with "misuse of official information," a third-degree felony, for reporting Rolando Arafiles, MD, to the Texas Medical Board. Had she been convicted, Mitchell could have faced up to 10 years in prison. However, after a four-day trial, a state jury in Andrews, TX, needed less than one hour to acquit Mitchell.
"We are very pleased about the not guilty verdict and that justice prevailed for Anne Mitchell," said Susy Sportsman, RN, president of Texas Nurses Association, in a media release. "If anything was to be gained from the absurdity of this criminal trial, it is the reaffirmation that a nurse's duty to advocate for the health and safety of patients supersedes all else."
That sentiment was echoed by American Nurses Association President Rebecca M. Patton, RN, who feared that a guilty verdict would have had "a lasting and negative impact on future nurse whistle blowers."
"Nurses play a critical, duty-bound role in acting as patient safety watch guards in our nation's healthcare system. The message the jury sent is clear: the freedom for nurses to report a physician's unsafe medical practices is non-negotiable," Patton said.
"However, ANA remains shocked and deeply disappointed that this sort of blatant retaliation was allowed to take place and reach the trial stage—a different outcome could have endangered patient safety across the U.S., having a potential 'chilling effect' that would make nurses think twice before reporting shoddy medical practice," Patton said. "Nurse whistle blowers should never be fired and criminally charged for reporting questionable medical care."
Attempts by HealthLeaders Media to contact Mitchell through her attorney following Thursday's acquittal were not successful. However, Mitchell told TNA she was relieved by the verdict.
"I was just doing my job," Mitchell said in a TNA media release. "But no one should have to go through this. I would say to every nurse, if you witness bad care, you have a duty to your patient to report it, no matter the personal ramifications. This whole ordeal was really about patient care."
TNA said that more than $45,000 has been donated by individuals and organizations across the country to the TNA Legal Defense Fund for Mitchell and former co-defendant Vicki Galle, RN. Prosecutors had dismissed charges against Galle on Feb. 1.
"No one in North Carolina should have to endure unwanted robo calls that tie up phone lines and disturb their peace and quiet," Cooper said in a media release. "People have had enough of answering their phones and hearing a recorded message."
The company commissioned robo calls to 100,000 North Carolina residents in October without following state law, which requires a live operator to announce the automated message and give recipients the chance to refuse the call, the AG's office said. The settlement is the result of complaints filed with the attorney general in October after robo calls were made by vendor Campaign Connections on Blue Cross's behalf to North Carolinians. Blue Cross agreed to stop the calls when the health insurer was contacted by state consumer protection lawyers.
"We regret this mistake, and we apologize for the error made in how these calls were placed. We continue to believe that it is important for BCBSNC to take an active role in the health reform debate," BCBSNC Executive Vice President and General Counsel Maureen O'Connor said in a media release.
The 35-second robo call warned against the healthcare reform bill that Congress was working on last October. The insurer told policyholders to expect a mailer containing a prepaid post card. They were asked to sign the postcard, which expressed opposition to the reforms, and send it to U.S. Sen. Kay Hagan, D-NC.
"From the beginning of the healthcare debate, BCBSNC has affirmed its support for health reform that covers all Americans, promotes quality care, and controls costs," O'Connor said. "The company has taken an active role in this discussion, particularly in educating North Carolinians on the likely impact of various health reform proposals. We will continue to be engaged."
Blue Cross is not legislatively exempt from the robo calls law, Cooper said, because it is not tax-exempt. The North Carolina General Assembly exempted some automated calls for healthcare and insurance purposes, but only for certain people, such as those who have business with the company, Cooper said.
The company has agreed to follow the law and adopt policies guiding its vendors to do the same. The $95,000 fine will go to the public schools in the state, Cooper said.
