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Health Care Tour: “Seeking Patient-Centered Care”
Spartanburg Regional Hospital
The Issue:
- Public hospitals face challenges with payment, placement and staffing. At the same time, technology is helping to reduce both errors and costs.
Findings:
- Hospitals face challenges with cash flow.
- Delays in receiving payment and bad debt totals have growing implications on the ledgers of the Spartanburg Regional Hospital System.
- Hospitals often have difficulty receiving payment from insurance companies. South Carolina does not have prompt pay laws requiring insurance companies to pay within 30 days or face penalties.
- Recovery Audit Contractors (RACs) - Medicare audits are being outsourced to contractors who often deny claims based on what they perceive as a lack of “medical necessity.” Procedures that were deemed to be proper care when treatment was initiated are often labeled as unnecessary in retrospect (hindsight is 20/20).
- Claim payments are withheld in total (no partial payments) until four levels of appeal are completed. Nearly 250 of SRHS’ 450 files audited since Nov 2007 have been withheld.
- Medicare Advantage? Many patients are unaware of what their plans do or don’t cover until they need treatment.
- Medicare Advantage plans usually offer additional benefits by reducing other benefits. For instance, many offer only 3 days of nursing home care after a hospitalization instead of the standard 100 days covered by Medicare. Without extended nursing home coverage, patients must stay in a higher-cost hospital environment.
- Nursing homes can be selective in accepting patients. Hospitals often negotiate with nursing homes to take difficult patients on a “trial basis” just to get them placed. SRHS discharges 150 patients each month to nursing home facilities. Each day 22-25 Medicare and Medicaid patients that could be placed in nursing homes stay in the hospital because of a lack of nursing home beds available for these patients.
- How do you incentivize wellness?
- Some see “capitating” patients (being paid the same amount per individual regardless of health status) as a solution. The incentive is then to make each patient as healthy as possible. It would require restrictions to keep providers from “cherry picking” the best patients.
- A Health Information Technology Showcase
- SRHS is rated in the top 3% of hospitals in the nation for the use of medical technology.
- Doctors have secure access to electronic medical records (EMRs) anywhere there is a web browser, even on handheld BlackBerry-style devices. EMRs prevent duplication of labs and medical tests.
- Wireless bar coding increases accuracy of drug administration. Ninety-six tele-medicine devices, called Telebuddies, have been ordered to monitor patients’ health status from their homes, saving trips to the hospital.
- A robot has been dispensing medications in the pharmacy since 1996 with no known errors and more than 99.99% uptime.
- Four “Tug” robots deliver medications from the pharmacy throughout the hospital. The “Tugs” can deliver meds to the farthest parts of the hospital within 30 minutes of the time the prescription is entered into the system. This also allows nurses to order standard medications for nursing stations without personnel having to leave the station.
- Nursing challenges – getting the right numbers in the right jobs.
- Nurses are used mostly in acute care and very little in community outreach. Studies have shown ER use is reduced by 43% when nurses are used to provide health education and case management.
- Nurses are in demand, especially nursing faculty. South Carolina turned away over 5,500 qualified nurses in 2007 because of a shortage of faculty to teach them.
When: February 20, 2008
Where: Spartanburg Regional Hospital, Spartanburg, SC
Hosts: Randy Nyp (COO), Sara Beth Hammond (VP of Contract Services), Jay Bearden, MD (VP for Research SRHS and Chairman, Medical Oncology, Gibbs Cancer Center), Raymond A. Shingler (Senior VP / CIO for Information Technology), Mary Jane Jennings (Vice President of Perioperative and Quality Services), Marsha Dowell, PH. D., RN (Dean of the Mary Black School of Nursing, USC Upstate)