A 242-bed acute care facility based in the beach town of Cape May, N.J., Cape Regional Medical Center serves a patient population that hovers under 100,000 during the off-season before swelling to more than one million during the summer. But for CIO Rich Wheatley, the operational challenges associated with a fluctuating patient base pale in comparison to the complexity of New Jersey’s HIE environment, which is about as “clear as mud.” Throw in Cape Regional’s plans to bring on physician practices, the challenges of juggling different systems, and the Meaningful Use timelines, and it’s safe to say that Wheatley’s job is no vacation. In this interview, he discusses his plans to integrate physician practices with the inpatient Siemens Soarian system, the use of Allscripts in the ED, his thoughts on the merits and weaknesses of Meaningful Use, and how he docked in Cape May.
- About Cape Regional Medical Center
- Actively acquiring physician practices
- A new Siemens Soarian customer
- Looking at NextGen on the practice side
- “Siemens is evaluating their ambulatory strategy”
- No Stark, but facilitating HIE connectivity for the independents
- The HIE morass in New Jersey
- Reading the tea leaves and moving forward
- Attracting the docs, fending off the competition
The year-round population of the county is about 70,000 and it grows to over one million in the summer time. So obviously, that puts a lot of stress on our emergency department, and subsequent hospitalization and inpatient visits.
We need to move forward with something sooner rather than later, and we’re not in a position to sit on our hands and wait for a strategy to develop from Siemens alternate from what they’re currently offering with NextGen.
It’s not clear in terms of how we’re all going to talk together, but bottom line is that we need to do what’s right for our community—not only from a patient safety and service standpoint, but also from a perspective of being able to fend off our competition.
They’re already angry. I think it’s perceived as the federal government making them do what they don’t want to do, and making them make investments that they don’t necessarily want to make.
And then you have the ones that are in between, and those are the docs that we’re really targeting and trying to work with. We’re trying to get them involved in what our challenges are as well as understanding what their challenges are, and offer services that can help them through that.
Guerra: Good morning, Rich. Thanks for joining me today. I look forward to talking to you about your work at Cape Regional Medical Center in the beautiful town of Cape May Court House. And that’s not Cape May proper—those are two different towns?
Wheatley: Yes they are, actually, Cape May Court House is about 10 miles north of Cape May.
Guerra: Okay, I think we drove through Cape May Court House on the way down to the beach.
Wheatley: Yes, if you’re on the parkway, you can see the hospital right from the parkway on exit 10.
Guerra: I was mentioning to you before we started the recording that my wife and I love Cape May and vacation down there quite often, so it’s a nice place to work, I would imagine.
Wheatley: Yes, it is. And I’m constantly amazed by how many people have either summer homes or relatives that have homes down here on the Jersey shore.
Guerra: Well, let’s start by telling the folks a little bit about the hospital. The Medical Center has approximately 242 beds, and is a stand-alone. We can talk about what that means, and also discuss the idea of the seasonal activity, how certainly there is a big boom in the summer and then it’s probably pretty quiet in the winter. Why don’t you start off with that.
Wheatley: Sure. Like you said, we’re 242 licensed beds, but we run about 120 average daily census, which is about 50 percent occupancy. We are the only hospital in the county, which is Cape May County. And as you also said, we have a very seasonal volume or population. The year-round population of the county is about 70,000 and it grows to over one million in the summer time. So obviously, that puts a lot of stress on our emergency department, and subsequent hospitalization and inpatient visits. We’ve done a few things to decompress our emergency rooms—for example, we opened an urgent care center across the street from the hospital, and that’s been a great success for us, both from a financial standpoint as well as helping to decompress that emergency department. But as you can imagine, in the summer time we get a lot of jelly fish stings, sunburns, and bar fights. You name it, we see it in our emergency department.
Guerra: Now it’s pretty family-friendly down there, but I guess occasionally people get all rowdy.
Wheatley: Oh there is some active night life on a variety of the islands—Wildwood and Sea Isle City, etc. And I think, like many hospitals, we’re actively recruiting new physicians and acquiring physician practices. About a year ago, we had no employed physicians, and today, we’re looking at double digit physicians on staff and we’re actively trying to recruit more.
Guerra: When you say they’re on staff, do you buy the practice so that now you have to support their ambulatory practice, or are you just hiring them to work in the hospital?
Wheatley: We are actually acquiring their practice and recruiting others into our Cape Regional Physician Associates practice.
Guerra: So, you are not stand-alone anymore.
Wheatley: That is correct, yes.
Guerra: Okay. Approximately how many practices have you purchased?
Wheatley: I would say half a dozen at this point, and we’re in a very aggressive mode to acquire more.
Guerra: So six practices, and are they multi-physician practices or single physicians?
Wheatley: It’s a combination of both.
Guerra: Okay. Now you signed a deal to go on Siemens Soarian, and you’re acquiring practices. My guess is most of them don’t have an EMR but some of them do. So how are you navigating these waters in terms of looking to eventually integrate these physician practices you’re acquiring with your inpatient environment, which is going to be Siemens Soarian?
Wheatley: We have an active effort going on at the moment. We’re really taking two tracks—one is that we have an MSO, which services not only the Cape Regional Physician Associates, but also another 20 or so physician practices from a billing standpoint and a practice management standpoint. So we are actively looking for EMR solutions to accommodate Cape Regional Physician Associates, and be able to provide those services to our MSO clients. The MSO clients represent about 40 practices.
In addition to that effort, we are also looking at health information exchange solutions, as not only do we recognize the need to integrate or interface with practice management software out there in the community, as well as our own, but we absolutely want to provide that kind of activity with our community and our other providers within the community.
Guerra: Siemens has a preferred partnership with NextGen. I’m sure you’re familiar with that. I’m not sure if Siemens is going to be coming out with an ambulatory EMR under the Soarian family. What do you know about those relationships or their plans to come out with anything? Does that effect how you’re going to move forward?
Wheatley: It certainly is a consideration. However, we are looking at the NextGen solution, as well as others, recognizing that there are certainly benefits to having that out-of-the-box integration available between NextGen and the Soarian solution. I am also aware that Siemens is evaluating their ambulatory strategy. I’m not sure where that’s going—I think I know as much as you do with respect to that. But we need to move forward with something sooner rather than later, and we’re not in a position to sit on our hands and wait for a strategy to develop from Siemens alternate from what they’re currently offering with NextGen.
Guerra: So you need to kind of read the tea leaves and move forward. Is one of your objectives to try and get as many of these practices? When you buy them, you pretty much own them, and you’re going to decide what they use. So are you going to try and pick one ambulatory product, whether it’s NextGen or one of the others, or if Siemens comes out with something, are you going to try and pick one and put that in all of your practices so you have one solution in the ambulatory environment?
Wheatley: That is correct. We want to get one solution in our Cape Regional Physician Associates, which is our owned practices, and then we wish to be able to then through our MSO, offer that same solution to our other MSO clients.
Guerra: What if you have a situation with the independent physicians where they say, ‘Listen, I’m not interested on being acquired, but I don’t have any EMR. If you want to do anything for me, let’s talk about it.’ Are you doing anything under Stark to influence the buying of the independents—somehow get some nice integration with them, or are you not doing Stark and just looking at that HIE type solution and putting up a cloud there to integrate any ambulatory products that the independents might be on?
Wheatley: Our approach is the latter of what you just said, and that is to provide that HIE connectivity. We are currently not entertaining the idea of providing any financial assistance through Stark or any other means.
Guerra: We’ll talk more about this later in the interview, but I know you’re very involved in New Jersey HIMSS, and New Jersey has a pretty strong HIMSS group. There is a lot of HIE stuff going on in New Jersey, and I’ve heard many people say that it’s kind of all over the place. There are different competing things going on here and there, and it’s hard for CIOs to figure out what’s going to be real and how to move forward. Does that make sense to you—does that resonate with you? Or do you see a clear path for you to go down in New Jersey as far as HIE is concerned?
Wheatley: I think it’s as clear as mud in terms of what’s happening with New Jersey and HIEs. We’re navigating the waters right now and just trying to figure out what’s the right path to take. We’re pretty far along that path, and I expect that we’re going to make a decision within the next 30 to 60 days.
Guerra: Is that going to involve an HIE vendor?
Wheatley: Yes it will.
Guerra: Okay so you need to pick an HIE vendor. So you’re really dealing with what most CIOs are dealing with, which is, ‘I don’t have clear information on how to move forward in a lot of areas, but I cannot wait.’ And probably when we get to Meaningful Use, there are still clarifications that haven’t been cleared up and FAQs that are unresolved. For CIOs today, you have to balance that need to move forward with the need to get information. So just tell me about how you’re dealing with that.
Wheatley: Well like you said, we need to move forward, because we want what’s best for our local community, in terms of how we connect with the state—how or if we connect within a local or maybe a state-funded HIE. The one down here includes Cape Regional, AtlantiCare, Shore Memorial, and South Jersey Healthcare as participants. Again, it’s not clear in terms of how we’re all going to talk together, but bottom line is that we need to do what’s right for our community—not only from a patient safety and service standpoint, but also from a perspective of being able to fend off our competition. We have a healthcare system to our north which is actively pursuing and acquiring practices in our backyard, so it’s up to us to make sure that we’re providing similar, if not better, solutions to compete with that.
Guerra: People sometimes forget that a hospital is really a place for physicians to work and they do that voluntarily, and they sell their practices voluntarily. So you need to be a very appealing place for these physicians to come practice. That’s really what it’s all about, isn’t it?
Wheatley: Absolutely, we have to make it as physician-friendly as possible. We want them to bring their patients here.
Guerra: Right. And as the CIO, you have to put these systems into place. Some physicians don’t want to use them, but luckily, one good thing about Meaningful Use is that everyone has to do it. So, it’s not like you’re moving forward and they can say, ‘Well, hospital B down the street isn’t forcing me to use it.’ Everyone’s got to use it. So how do you roll out these systems and get adoption of them without making physicians angry?
Wheatley: Well, they’re already angry. I think it’s perceived as the federal government making them do what they don’t want to do, and making them make investments that they don’t necessarily want to make. And I think it runs the spectrum; there are certainly those younger physicians that already have an EMR today that are anxious to exchange data with us, and those are the docs that we love.
At the opposite end of the spectrum are the physicians that are approaching retirement age, and they are probably not going to make a move into the EMR world. They figure that within the next five years, they’re going to be retiring. Or if it goes beyond that, if you take a piece of their revenue or Medicare reimbursement away from them, I think that they just look at that as a cost of doing business, and offset that by what they would have to invest in an EMR. And not only invest in the EMR itself but also the cost associated with that learning curve and that ramp-up time, and understanding that they won’t be able to see X number of patients a day as they are typically used to. That’s going to decrease initially and then eventually ramp up back to their current levels, but it’s going to be a six-month process.
And then you have the ones that are in between, and those are the docs that we’re really targeting and trying to work with. We’re trying to get them involved in what our challenges are as well as understanding what their challenges are, and offer services that can help them through that. Certainly the state and federal government are helping out in terms of New Jersey HITECH, and we’re partnering with them in order to provide those services to the physicians so that we—or at least our New Jersey HITECH—can then offer workflow analysis and really help those offices through this transition period.
Guerra: It’s a tough argument to make, right? To say, ‘I’m going to increase your cost and decrease your revenue.’
Wheatley: Yeah, it’s a tough one.
Guerra: Would you say that one of the best things about Meaningful Use is that it’s forcing everyone to do it, so they can’t say, ‘Well at this other hospital, I don’t have to do it’?
Wheatley: I think that’s certainly one of the benefits, sure. I can’t argue that.
Guerra: It pushes everyone at the same time?