Hold on! Let me take a selfie...

What a Summer MPMC has had!  Many changes have been made in many areas and a majority have had a very positive effect.  The overall financial picture is improving; the community, staff and all providers have seen improvement.  Morale, while it ebbs and flows like at any other business, is better.  Though we have a lot of work left to do, I am proud to report that patient satisfaction scores are doing well and continuing to rise. 

I wanted to give some updates on some projects that are nearing completion…but first, let me take a selfie….

Wicked selfie skills.

 

The email server migration is taking place tomorrow morning (8/23/14).  Email will be down for 24 hours so please refrain from checking your email under Sunday after 5am.  Also, please check ALL your mobile devices (smartphones, tablets, laptops) and turn the auto email check function off.  Elizabeth, John, Evaldas and Synoptek will be available Monday for training and questions. 

The final large item that will require IT downtime will be the IT server migration to Denver, which will take place the weekend of 9/6/14.   After this migration, all data will be accessed through our new network in Denver.  There will be a clean-up period where user issues will be rectified as we find them. 

The CEO search is going well; two candidates have scored exactly equal per Centura Health’s talent evaluation scoring.  Both candidates will be interviewing at MPMC over the next month.  The first candidate is scheduled to interview with the Board, Leadership, Managers and Staff this Monday and Tuesday, 8/25 & 8/26/14 (see the all MPMC email from earlier this week). 

The other candidate…hold on let, me take another selfie…

Dr. Stuerman, Brendan, Myself reppin' MPMC at recent Golf Tourney (photo courtesy and not pictured Jason Bryan)

 

…The other candidate will be interviewed soon as well.

July was the best month in hospital history from a financial stand point.  I am sure most of you felt this with the volume of patients we had come through the organization.  Kudos goes out to the entire organization for taking this in stride and maintaining excellent patient service.  Now that August has rolled around and schools have started…things have slowed down a bit.  Hopefully this will give everyone a short breather until ski season kicks into high gear again. 

After my 3 month hiatus from the blog expect to see this regularly…the info, not the selfies.

As always, thank you all for your dedication and your hard work!

 

 

Good stuff!

A number of exciting announcements and updates have transpired recently. These opportunities position Middle Park Medical Center for sustainable growth and improved patient care. The leadership team wants to keep you informed of these advancements as they occur, and welcome your feedback and questions.

 

Centura Health management agreement

On Friday, May 2, 2014, the Kremmling Memorial Hospital Board of Directors held a special meeting to vote on the Centura Health management agreement.

The meeting was well attended by staff and community members, many of whom voiced their support of the measure and asked several clarifying questions. After the board, our leadership team and a representative from Centura Health addressed the questions and comments during the meeting, the board voted unanimously (with one board member absent) to enter into the agreement.

See the attached letter from Board President Mark (Bernie) Murphy about the agreement and what this decision will mean for MPMC and the communities we serve. The leadership team emailed the letter to all staff and distributed it in paper form to break areas and nurses’ stations on Friday evening following the meeting.

This is an exciting time for all parties, and looks to strengthen MPMC’s overall sustainability.

 

Board meeting highlights

The Board of Directors also held its regular monthly meeting last week – on Tuesday, April 29, 2014, at MPMC-Granby.

There are many positives coming to fruition within our organization. March 2014 produced the third best gross revenue in district history at more than $2.3 million. Factoring in bad debt and contractual adjustments resulted in a net revenue of nearly $1.7 million. Salaries and benefits were under budget. Continuing cost containment has left us within $6,500 of our budget, and more than $23,000 less spending than a year ago.

Year-to-date numbers are even more impressive, as gross revenue for 2014 is 5% greater than the same period a year ago. Salaries and benefits came in at more than $76,000 less than the same period in 2013. Operating expenses were $90,000 less than a year ago, with the year-to-date numbers forecasting the organization operating more than $825,000 below last year’s expenses.

Cash at the end of March was $466,525, remaining at about nine days of operating cash on hand. Accounts payable (A/P) decreased by about $50,000 from February to March 2014. Days in accounts receivable (A/R) (net) sits at about 82 days. The district’s cash position and A/R continue to trend in the right direction but cash flow challenges will likely continue through 2014.

Total payables showed a slight increase in March, though trade accounts have been trending modestly in the right direction since mid-February. Cost-saving measures and staffing changes are expected to make more cash available for the reduction of A/P in the near future.

We expect to receive the bondholders’ report this week. The bondholders did encourage the board to sign the Centura Health management agreement. We are confident in our relationship with the bondholders and their commitment to helping MPMC grow and thrive.

 

Information technology

The information technology upgrade has begun. The space at the Critigen server farm in Denver has been upgraded to provide space for our data. The network hardware has been ordered and is expected to be in soon. The entire network upgrade and data transfer to Denver should be complete in 90 days.

I will share more information on this progress as it is available.

 

Electronic medical records

Centura Health is evaluating its future direction related to electronic medical records (EMR) and how its programs will integrate with MPMC’s software.

The process is nearly complete, and the leadership of both Centura Health and Middle Park Medical Center will meet after the Centura Health board meeting on May 6 to discuss next steps and timelines.

MPMC and Centura Health are currently looking at Epic, Cerner or Meditech 6.1 for the EMR system.

Centura Health is committed to working with MPMC to upgrade and integrate our systems. I look forward to working together with their staff to provide excellent patient care to the people we serve.

 

Please stay tuned for additional updates as they become available. Thanks so much for all you do and for your commitment to the organization and our communities!

Dr. John Wisneski submits resignation

What this means for MPMC and our patients

John Wisneski, M.D., announced Tuesday his resignation from Middle Park Medical Center. His last day will be June 30.

Dr. Wisneski sees patients in the clinic in Kremmling and the emergency departments in Kremmling and Granby. He has been a part of the Middle Park Medical Center team since 2005.

"I have deeply enjoyed working with all of you at Middle Park Medical Center and developing relationships with my patients," Dr. Wisneski said. "I will miss you and always value my time here. I know that MPMC is destined for greatness and will continue to grow and thrive. Thank you for making this experience a great one."

Our CEO Cole White said that Dr. Wisneski’s relationships with his patients speak volumes about his commitment to health care and his community.

"Dr. Wisneski engages patients and builds trust with his patients, and we will certainly miss his leadership," White said. "We know that Dr. Wisneski’s patients and all of our staff will feel his absence."

Dr. Wisneski is currently our Chief of Staff. Dr. Lynnette Telck of North Park Medical Center in Walden, who is currently our Vice Chief of Staff, will assist in the transition over the next 90 days.

We have already begun recruiting a new provider for the facilities. All of MPMC’s providers are accepting new patients and will work with Dr. Wisneski in transferring patients to their new provider of choice.

Updates on exciting initiatives and financial news

 

 Service Excellence Advisor graduation

Yesterday was the Service Excellence Advisors’ (SEA) graduation ceremony, and it was a great event to kick off this team of frontline workers’ journey into the realm of teaching service excellence to all MPMC staff. Members of the administrative team spent two hours yesterday morning in a question-and-answer session, and I believe I speak for the entire administrative team when I say that the SEA members are going to make MPMC shine!

It was awesome to feel the positive enthusiasm in the air during the event. The team is truly passionate about its work, and the advisors are eager to roll out the program. Thank you to the Service Excellence Advisors for their hard work! Speaking personally, I truly believe they will have a positive influence on our operations and that everyone will want to follow their lead in this initiative.

 

Centura Health management agreement

One important topic we have been discussing recently is the Centura Health (CH) management contract agreement. The goal was to sign this at the March 26 board meeting. However, as we mentioned in the Connect with Cole meetings, MPMC’s bondholders sent a consultant out to assess the overall operational and financial health of MPMC. All parties have decided to put the signing on hold until this report comes out, which is expected to be in the next week or so. MPMC has had nothing but positive communications with the consultant, and the leadership team feels confident about the impending report.

 

Medicaid reimbursements and cash collections

One very good piece of news is that Medicaid has sent MPMC notification that MPMC has been underpaid for quite a while. Medicaid failed to adjust their reimbursement models to the current models. This means that MPMC will be getting a total reimbursement of about $650,000 over the next couple of months. This is great news and puts MPMC in a better financial position!

Another good note is that MPMC was in the black for month of February to the tune of about $88,000. Also, upfront cash collections have drastically increased from $80,000 in January to $125,000 in February. We are approaching the $125,000 mark already for the month of March. This is huge for our bottom line.

The revenue cycle is seeing vast improvements. Kudos to Jodi Docheff and the Patient Financial Services and intake staff, Patti Bushey and Health Information Management staff, Bethanie Reynolds and Mary Jo Hargadine and the entire nursing staff!

We are making gains, and we know this is no small part due to the team effort we are all exuding. Thank you, everyone, and keep up the great work!

A letter from the CEO.

Dear Middle Park Medical Center staff:

At last week’s Board of Directors meeting, a few employees expressed their interest and concern in Middle Park Medical Center’s current situation and opportunities for the future. I, along with the board and the leadership team, welcome employee input and feedback and am encouraged by the passion and energy shared.

I understand that our employees want information about the achievements, challenges and decisions of our hospital’s leaders, and I want to share that information in timely and effective ways. The leadership team is working to implement such strategies – under advisement from the lean workgroup focused on communication and through the work of our human resources and public relations departments – ranging from email and newsletter communication to leadership rounding and employee meetings with me.

Our Service Excellence Initiative – with its Advisors, Council and lean workgroups – is one way that the leadership team and the Board of Directors are exhibiting our commitment to each of our employees. We strive to gain meaningful feedback from you as we all work to improve the service we provide every day in our communities. We are investing in you and striving to provide you with the resources and opportunities you need to feel successful and satisfied in your job.

The hospital is experiencing some financial constraints that are encouraging us to reevaluate some of our business strategies to decrease expenses and increase revenue. Optimizing value is about more than just finding places to cut costs. We want to maximize resources to increase our return on investment. Improving efficiency and effectiveness means doing our work better, not just cheaper. Please be assured that during our discussions, patient safety and satisfaction are at the forefront of our decisions and that we will maintain the same top-notch patient care that we have continuously provided.

In December 2013, Middle Park Medical Center used monies held in reserve to make the bond payment associated with the Granby facility. Bond covenants require that MPMC replace the monies back into reserves within the next six months.

I, as well as members of the leadership team and Board of Directors, will be meeting with the bond holders this month to tour our facilities and assure that we are able to comply with the bond covenants. So far, our bond holders are satisfied with our operations, and our relationship has been strengthened by these communications.

We will be able to pay back our reserves and continue forward with our reliable payment schedule. However, we will be looking at cost-saving measures to keep this organization moving forward and financially strong. We have already implemented a spending freeze to eliminate non-essential expenditures.

One primary resource for improving our financial stability – and therefore the ability to continue to provide high-quality care to the residents of Grand, Summit and Jackson Counties – is to consider a management agreement with a larger health system.

In August 2011, Centura Health and MPMC signed an affiliation agreement to establish an expanded system of care for MPMC. Currently, Centura Health and MPMC are exploring opportunities to expand their affiliation agreement which may include a management agreement.

Under a management agreement, Centura Health would provide management and leadership expertise under the direction of a Centura Health-employed chief executive officer, appointed by Centura Health and approved by the MPMC Board of Directors.

Through the proposed management agreement, the Board of Directors would retain its governance and authority over MPMC as well as fulfill its ongoing role to provide the strategic direction of the hospital. The CEO would run the hospital operations on a day-to-day basis and work with MPMC to identify areas where additional clinical and operational services, education and resources are needed. MPMC staff would have significant support and access to colleagues and partners throughout Centura Health with whom they can discuss challenges, explore best practices and obtain feedback to help determine high-value health care solutions for our communities.

The details and negotiations of a management agreement are ongoing and are sensitive legal matters that require us to maintain confidentiality until an agreement is signed. The Board of Directors aims to sign the agreement at its March 26, 2014, meeting.

In recent years, we have enjoyed a positive and uplifting relationship with Centura Health and look forward to the additional benefits a management agreement could bring – lower operating costs, improved negotiating power with vendors and an expanded marketing approach to draw new and returning customers.

Other future cost-saving measures may include: staff adjustments and realignments, a moratorium on overtime without explicit pre-approval, service line revisions, a service price increase, the 401k match becoming a discretionary benefit based on the organization’s financial performance, selling unused equipment, and renegotiating insurance contracts to ensure maximum reimbursements for services rendered.

Please be assured that each of these decisions is made with much consideration and research while keeping patient care our highest priority. We understand that change is hard and can cause some to have feelings of uncertainty about MPMC’s future. I want you to know that this is hard for everyone, including myself, the leadership team and the Board of Directors. We value each and everyone one of our employees and are carefully deliberating to make the best decisions possible for all of us and the community.

These decisions are also made under the guidance of our 2014 strategic plan, carefully built with input from the leadership team, managers and the Board of Directors. We are committed to staying true to the ideals and priorities presented in our strategic plan and use it as our guide for making difficult decisions.

I hope you will take the time to review our strategic plan, sent out as an attachment with the all staff email and available on the main page of MPMC’s intranet – intranet.kmhd.local.

I want to note that the financial challenges MPMC is facing are not unique to us. Rural hospitals throughout the nation are facing looming challenges. Health care has been on an unsustainable track, with skyrocketing costs and inefficient systems producing uneven results. The pressures on the health care delivery system are becoming more urgent. Reduced reimbursement rates and demands for proof of performance mean that we have to improve our efficiency and operational effectiveness every year just to stand our ground.

Please contact me if you wish to discuss any of the items discussed in this letter further or provide cost-saving suggestions. Also, look forward to an announcement soon about face-to-face staff meetings with me to hear your feedback and answer your questions.

We are moving in the right direction, and I am confident that with some carefully considered operational and strategic changes, we can correct our financial challenges.

Thank you for staying positive in this time and for continuing to provide the best patient experience possible!

 

Thank you,

Cole White
Chief Executive Officer

Getting lean and mean...

Rural hospitals serve 54 million people in the United States.  This is 1/6 of the nation’s population.  One would think that with that number rural hospitals would be more profitable.  However, this is difficult due to the fact that 9 million of the 54 million are Medicare recipients.  According to the American Hospital Association (2014), rural hospitals have the lowest profitability in terms of Medicare profit margins. 

Couple the inability for rural hospitals to negotiate favorable insurance contracts, Obamacare, the cost of needed (government mandated) IT investments, and the increasing self-pay patients; rural hospitals struggle to be profitable. 

MPMC is no different from the typical rural hospital.  Large insurers such as United Health Care reimburse us lower than the Medicare rate on majority of the care we provide to their members.  Considering the number of United Health Care patients we see is as high as 25%, this is a considerable dollar amount.  This is where MPMC’s affiliation with Centura Health (CH) comes into play.  CH has the ability to use its’ large size and clout to negotiate much more favorable terms with United Health Care. 

Kelly, T. (2010) states that “Systems with 50 hospitals have more leverage in negotiating with a health plan, whether it be a small regional in their area or one of the large nationals, than a stand-alone smaller rural hospital has.”

Obamacare, or the Affordable Care Act, has created another monster of its’ own… In order to afford the plans presented and meet the criteria to be insured patients are signing up for low premium- high deductible health care plans.  This means that patients who come into the ER have to meet 5 to 7,000 and sometimes even 10,000 dollar out of pocket expenses before their insurance picks up the rest.  This is difficult for most patients to pay for. 

With the above mentioned, MPMC has a great deal of money outstanding, or in accounts receivable (a.k.a days in A/R), that is owed to us.  This number is in the 7-8 million dollar range.  In this between 40-50% of this are self-pay accounts.  What is interesting is that self-pay (non-insured) is only 10-12% of the patient load, but they account for nearly half of the money owed to MPMC.  The chances of MPMC seeing most of this money are not good.  In short, MPMC cannot pay its’ bills if patients do not pay their bills. 

Next, the AHA (2014) has stated that the increased regulations and need to implement expensive information systems creates strain on the profitability of small hospitals.  It is common knowledge that MPMC has had IT and EHR struggles in the past.  With the affiliation with Centura Health, we have a partner that is committed to providing us with an IT and EHR system that works well.  Also, with The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, MPMC can recoup 85% of the cost of the system.  That means that the entire cost of the entire system, nearly 2.25 million dollars, will be paid back by the federal government.

While most of this sounds like doom and gloom MPMC does have a plan to be profitable.  This includes:

1.      Implement urgent care services for low level ED visits that require payments up front before services are rendered

a.       Up to 55% of our ED’s are self-pay and most pay nothing

2.      Improved revenue cycle through checks and balances, and move to Centura EHR and revenue cycle systems

3.      Adjusting staffing models to become Lean (or Leaner)

4.      Re-negotiating insurance contracts with Centura’s clout.

a.       Currently United Health Care reimburses us about 40% for the cost our services

b.      All other insurers reimburse 85-95% of our costs

c.       This would mean a large increase in revenue

d.      This is already underway

5.       Selling assets that are not used

6.      Implementing a price increase to become competitive

a.       MPMC has not implemented one in 3 years

b.      Currently some of MPMC’s prices are at 30% of the prices of other hospitals of our size and region, according to Craneware (leading chargemaster software in US)

c.       A discharge from St Anthony’s in Lakewood averages around $70K, MPMC around $7k

d.      A CT scan in Summit costs about $3200, MPMC is $1600

7.      Increasing more referrals to Centura facilities to get them returned for increase swing bed days and services that can be done at MPMC

a.        This includes keeping more patients here for care rather than referring out to other facilities

Those are some of the plans of action that the senior leadership team has identified to become more profitable and sustainable.  In the next two weeks we (senior leaders) will be holding mandatory town hall meetings at various locations to better communicate the issues and address the concerns. 

Thanks for all you do!

 

References

American Hospital Association (2014). Rural health care. Retrieved from: http://www.aha.org/advocacy-issues/rural/index.shtml

Kelly, T. (2010). Small hospitals face heavy weather. Managed Care. Retrieved from: http://www.managedcaremag.com/archives/1003/1003.smallhospitals.html

 

 

A new way of communicating.

As Middle Park Medical Center continues to expand our services to the residents of our communities, the leadership team strives to communicate effectively and often with the MPMC family. We want you to be apprised of the hospital’s happenings without being inundated with emails.

To that end, “all MPMC” will be going through myself and Michelle Balleck, Director of Marketing and Public Relations. We will then be condensing most emails that need to be shared hospital-wide into one weekly email that will arrive in your inbox each Monday. We will make this email simple, to-the-point and bulleted for your ease of reading.

When you have messages that need sent to the entire staff, please send them to "All MPMC" all_mpmc@mpmc.org for inclusion. Messages need to be sent to this email by 8 a.m. Mondays to be included in that week’s organization-wide email.

Exceptions will be made, and emails sent immediately, for any issues that necessitate immediate attention or action.

Please stay tuned as we roll out more communication tools to help us all stay connected over the coming months.

Do not hesitate to contact myself, Michelle Balleck, or any member of the leadership team with your questions or feedback. We want to share information in an effective and efficient way and help MPMC be the best that it can be.