These days, it’s all about alignment. As organizations face increasing pressure to position themselves for healthcare reform, leaders are finding that this isn’t the time to be on an island. With that in mind, Skaggs Regional Medical Center recently entered into a merger with CoxHealth. But of course, that doesn’t mean the work is done. In fact, it’s only beginning. In this interview, CIO Michael Elley discusses the challenges of adjusting to new workflows, his plans to migrate to Cerner, and the work his team is doing to reduce readmissions. He also talks about the BJC Collaborative, how the organization is using business intelligence to plan for fluctuations in patient volumes, and his career path.
- Super-users & key stakeholders
- Resource planning with McKesson’s BI tools
- T-System’s Care Continuity solution
- From 11.5% readmissions to 7.8% in 2 months — “It’s already had a profound effect on our organization.”
- Attesting to MU using the ED-only method
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We really wanted to see what we can do, not only from a perspective of ‘we want to limit the amount of that 1 percent reduction,’ but also, we really needed to be focused on improving the health and wellness within the community that we serve.
It really helps us dig down and dig deeper on our patients and really help manage their care much better.
It allows us to send the ER chart, and if they’re admitted on the inpatient side, it lets us to send that inpatient chart as well to that provider so they can really have an inclusive view on why that patient was in the hospital.
After only two months, for chronic heart failure, COPD, and diabetes, our readmission dropped to 7.7 or 7.8 percent. So it’s already had a profound effect on our organization.
We cannot flip on this deadline date of March 1. I’d like to have about 90 days stabilization before we meet stage 2, but if we start on March 1, this will still give us about a month to stabilize and make sure that we’re able to hit our numbers.
Gamble: You talked about the changes before that the staff has had to deal with — not just the merger but then also migrating to Cerner. I imagine that there are some challenges there with change management. Do you have clinician leaders or different representatives from the departments who you sit down with to address this? How does that work?
Elley: You mean in terms of deploying the new Cerner solution throughout the organization?
Elley: Oh sure. They’re very involved. All the departments have not only department heads but also key stakeholders, whether they’re super-users or just key subject matter experts that are involved throughout this entire process — pharmacies or lab are great examples. So we have the key individuals out of those departments working not only with IT, but with the key pharmacy people and the key lab people from the parent company side as well to help standardize and make our systems as much alike as possible. We would like to have a vision of some day in the future — and like I said, the organizations are only about 30 or 40 miles apart — where we can have a nurse or a lab tech or whomever shuttle back and forth between the organizations when needs arise.
Branson is a very tourist-driven area. It’s a town of 10,000 to 11,000 people, but they have eight to nine million tourists come through every year. The volume is very, very high in the May through December timeframe, where usually volume tends to be a little bit higher in the winter timeframe at some other organizations, and so maybe there’s a way to share those resources. We need to standardize as much as we can so that we can share those resources.
Gamble: Right, that makes sense. I can imagine that there are planning challenges when you’re talking about a significant change in volume for those months.
Elley: It’s very difficult to use predictive modeling to understand what those variations are going to be. We’ve recently deployed a BI tool from McKesson that’s been very instrumental in allowing us to do that. We’ve already seen that we’ve been able to trend six, eight, nine months ahead based on historical data, and it’s pretty close to what we’ve trended in the past. So we’re doing better at preparing for our future volumes and our future needs.
Gamble: Another thing I wanted to talk about was that work that you’re doing to reduce readmissions. This is something that obviously is such a big issue and that we hear a lot from CIOs dealing with the new payment models. I wanted you to just talk a little bit about the work you guys are doing on this end.
Elley: We, like all hospital organizations, could see a 1 percent reduction in Medicare reimbursement based on our 30-day readmission levels. So we really wanted to see what we can do, not only from a perspective of ‘we want to limit the amount of that 1 percent reduction,’ but also, we really needed to be focused on improving the health and wellness within the community that we serve. We serve about three counties in our service area. It’s a very high Medicaid, very high self-pay population, and so a lot of them don’t have a primary care physician and they utilize the emergency room or urgent care as their primary care physician. We needed to figure out a way to get those patients into a primary care setting — one, it’s cheaper for the patient to go see their primary care doctor or even a specialist on a routine schedule versus coming into the ER, and two, it’s financially more feasible for us, if they’re a self-pay patient, if there’s some sort of payment plan that we can work out with them through a primary care setting versus an ER setting.
We utilize T‑System within our ER. T-System has a module called Care Continuity that’s really focused around moving patients to different primary care physicians, moving patients to specialists, setting up triggers for patients who are deemed high risk, or just setting up other type of triggers so that we know the type of patients that are coming in to our ER and how to best handle them. For instance, if a patient comes in and we identify that they do not have a primary care physician, that sends the patient into a queue. We have somebody working the queue that can help find a physician based on the patient’s preferences. So if they want a male or a female doctor or they live in a certain area, we can work with them to get them established with their primary care doctor and get them set up for that first appointment so that can really establish that relationship and they’re not utilizing the ER as a family physician.
If patients come in more that three times within six months, it sets up another trigger and another queue for us to identify why the patient is coming in and really dig deeper and work with the patient. Maybe it’s the middle of summer and they don’t have air conditioning, so it’s cheaper for us to buy them a $300 air conditioner and put a wall unit in their house, versus them coming into the ER because of that. So it really helps us dig down and dig deeper on our patients and really help manage their care much better.
Gamble: Now as far as the physician offices that you work with to set up the appointments — are those owned by the health system? Or are they affiliated?
Elley: Right now, they’re employed. We don’t use the word ‘owned,’ but the physicians are employed by the system. There are about 60 providers just within the Cox Branson area. In all of CoxHealth, there are roughly 500 providers or so that are employed. But in our area, there are about 60 providers that are employed, and so we are able to route those patients to those providers. But honestly, we’re also going to roll this out to the independent providers in our area, because it doesn’t really matter to me if they’re employed by us. What really matters is that these patients receive timely care and establish a relationship with their primary care base. And so we will allow and train independent providers on basically a web app that they will log into and they can go in and see if their patients have ever been in the ER or if they’ve had patients routed to them or anything like that. And that will increase the amount of providers that we can get these patients to.
Another good thing about the system is that it allows us to send the ER chart, and if they’re admitted on the inpatient side, it lets us to send that inpatient chart as well to that provider so they can really have an inclusive view — at least from that last visit — on why that patient was in the hospital.
Gamble: I don’t have the data but I’m sure there’s data showing that if an appointment is already set-up before the patient even leaves the hospital, the chances of them getting follow-up care increase exponentially.
Elley: Absolutely. I’m on a team right now trying to identify what’s the best way — short of some sort of centralized scheduling system, which a lot of providers really don’t like — to make sure that we have those patients set up, especially on an inpatient side. It’s more difficult on the ER side for the simple fact that usually the clinics are open during the day, and it’s hard to schedule them with their primary care physician if a patient comes into the ER at 11 o’clock at night. But if that patient is being discharged from an inpatient setting, we largely know their length of stay. If a patient has a certain diagnosis, they’re probably going to be in our organization for three days, so even on day one, we can work to start establishing that appointment with their doctor for follow-up care.
Gamble: That’s interesting, and this is something so many organizations are looking to improve, so it will be interesting to see how you guys continue to do with that.
Elley: We’ve only had this solution for five or six months now. I think we were trending at about the state average for readmissions, around 11.5 percent, but after only two months, for CHF (chronic heart failure), COPD, and diabetes, our readmission dropped to 7.7 or 7.8 percent. So it’s already had a profound effect on our organization within two months. It was a good turnaround.
Gamble: That’s great. Now I know that there are a whole bunch of projects you have on your radar, and one of the ones I would like to talk about was Meaningful Use. I’m wondering about what you’re doing with Cerner and how that’s affecting attestations. Is it something where you’re waiting to attest? Where do you stand with that?
Elley: What’s Meaningful Use? I’m joking. So like I said earlier, we are largely a tourist area, and so we have 165‑bed hospital, but we have roughly 40,000 ER visits annually. Due to the volume through our ER we were able to attest in 2012 through the ED-only method utilizing T-System, and so we’ll do the same thing for the second year of stage 1 utilizing our ER volume and T-System. But what we’re going to do with the Meaningful Use — and a lot of this hinges with ICD-10 coming down the road — is that for 2014, you have to meet it for a quarter; not just 90 days, but for the quarter. We don’t want that to run through all the last-minute work that probably will be going on to prepare for ICD-10, which would be July through September. And so we’re shooting to meet that quarter at stage 2 Meaningful Use in 2014 between April and June.
That’s why it’s very key for us to deploy Cerner, and that’s why it’s very important for us that we cannot flip on this deadline date of March 1. Honestly, I’d like to have about 90 days stabilization before we meet stage 2, but if we start on March 1, this will still give us about a month to stabilize and make sure that we’re able to hit our numbers for stage 2 April through June.