JSMC works to address community expectations

CEO of Jennie Stuart Medical Center Eric Lee recently met with New Era Publisher Taylor W. Hayes, Editor Eli Pace and Opinion Editor Jennifer P. Brown to answer questions about the hospital and changes in health care. The interview lasted more than an hour, and in this, the second of a two-part series, the questions are primarily about the hospital and the hospital’s role in the community.

Pace: How is a community hospital fundamentally different from a university or for-profit hospital?

Lee: The biggest difference is at the board level. In a community hospital, like Jennie Stuart Medical Center, you have a strong board who is very committed to keeping its health care, the impact of that health care and the decisions about that health care, and what is available, local. Having local control and the ability of this community to self-determine where we want our health care to go, that is the single biggest advantage we have.

 

Let’s just say that LifePoint owned Jennie Stuart Medical Center … they’re going to do whatever they think is going to increase shareholder value. Obviously, our board wants the hospital to be financially healthy, but we do not operate from a standpoint of ‘What do we do to maximize profits?’ We see our role as being a healthy employer and a healthy corporate citizen in the community. … We have multiple roles, not just profit orientation. … You have 12 volunteer board members who are all community business people, and they believe in the value of having local control and self-determination on the future of what health care services are provided, what types of specialties we want to recruit and what this community needs in terms of its health care from a medium-sized hospital. There’s a tremendous amount of satisfaction in that, and I would say that’s the single biggest differentiator.

When it comes to ability to provide medical equipment or facilities, there’s really no difference at all in most hospitals. We have the same or better radiation therapy equipment. We all use the same drugs and pharmaceuticals. Our nurses and physicians are trained at the same colleges and medical schools. We have access to the same diagnostic imaging technology and lab technology that the Nashville facilities have.

Hayes: (The hospital) recently launched a rebranding campaign. Is there a perception that the cost is higher or the treatment people receive at Jennie Stuart is inferior to that of other hospitals?

Lee: We look at data on costs of health care, and we fit very favorably. If you look at the bell curve for provider costs, we’re probably a little bit below the median in this large region. The one thing that I’m very proud of is it’s going to become increasingly important that you be a very cost-effective provider moving forward. Particularly, as people get more price-sensitive, which that day is coming, we’re well-positioned there.

A lot of hospitals that are these high-cost providers, they’re going to struggle with that in the years to come. Not right now. Not next year. But at some point in time, they’re going to be forced to reckon with that.

Absolutely, we do have to battle a perception problem in the community. … We have been very honest about this for some time. We have tried very hard to recognize where our quality is not meeting community expectations. When we get a complaint or when somebody calls us and says they had a bad experience, we listen to that. The best example I can give is it became very, very apparent very early in my tenure as CEO that our ED, our emergency department, was not meeting the expectations of people in this community.

Long waits. Not meeting service expectations. People were not happy with the quality of medical care they were receiving. They felt like they were in the ED too long or they weren’t properly diagnosed. And so 2011, quite honestly, was a very trying year as we made the decision to transition away from the emergency physician group we had been working with for a number of years. We really began to implement a culture change. … we brought in a new ED group and new management. We took a very valuable core of staff that we’ve continued to build on that with new staff that really understands the concept of emergency medicine and customer service. Our team has done a tremendous job of turning things around, and I’m hearing it from people I talk to in the community. … But what we did is we said we look at ourselves as competing with the Nashville market … what we said is ‘What do we have to do to really effectively compete?’ And with Dr. Green’s help, who’s the president of the new medical group in the ED, we went after one of the physicians leaders in the emergency department in Centennial Medical Center, Dr. Randy Ellis. Dr. Ellis was practicing right in the midst of HCA; they’re famous for their billboards as you come into Nashville. You know ‘Fast ER.’ He’s a student of that environment and he brings that expertise to Jennie Stuart Medical Center.

And he helped us recruit one of the nurse managers from Centennial. Deb Flowers is our new clinical department director of the ED. And I give Beth McCraw, who for a good part of her career was at Baptist Medical Center in Nashville, and that was one of the reasons I wanted to promote Beth very early in my tenure as CEO, because I knew that she had that experience and she understood what those competitive challenges were and she understood what our market was looking for. And plus, being a hometown person, she understands our local market.

So I think we’re working diligently to address the concerns and we listen. …

The reason we’ve worked so hard on the “I am Jennie Stuart” campaign is we realize that we’re not just trying to change the community’s perception of Jennie Stuart, we’ve got to start internally. If your own employees don’t believe that you’re a great hospital and in their individual power to make a difference, I can have town hall meetings once a week and talk until I’m blue in the face and it’s not going to change how our employees interact with and treat our customers.

A big part of the “I am Jennie Stuart” is to focus on our employees who really get it, who really understand customer service and who understand their craft and draw attention to the wonderful job their doing. …

Brown: The county health rankings paint a pretty dismal picture of the health of the community. Does Jennie Stuart have any specific plans to tackle some of the community’s poor health stats?

Lee: Obviously, we’re a big part of the care people receive in this community. The ED department is a significant safety net for the community, and, quite honestly, convenient care was initially designed as a clinic that was available for people to access quality physicians after hours; it certainly wasn’t designed as a safety-net feature. But in many respects, we’re seeing it has become a safety net for primary care for people in this community. …

We do not have a real strong public health component to our mission because we are an acute care provider, and we focus on the acute aspects of medicine. Certainly though, we are being encouraged by the federal government to do a lot more coordination with the other health care providers in the community, and to tie in to our strategic planning and community health planning.

There’s a much bigger push these days for community-health planning. And one of the things that we’re trying to do is work more regularly with both Pennyroyal Mental Health and the health department to say ‘How can we share resources? What can we do to better coordinate care?’ Because when you think about it, Western State typically operates in a vacuum. Pennyroyal Mental Health, the health department, Jennie Stuart, long-term care, and in some cases a number of medical practices in the community, we all operate in our own vacuum. We’re starting to break through that. We had a flurry of meetings in 2011 with several (health care providers), particularly the health department and Pennyroyal Mental Health, but also with a lot of the long-term care providers, one of the things we have to do moving forward is do a much better job of continuing to meet and look at how can we share resources and coordinate community care better.

I know Mark (Pyle) and his team at the health department are very concerned about the health care stats. But you look at our region, and we’re got relatively high unemployment particularly when you compare us to national standards and we have a fairly high level of poverty here. A lot of our problems are consistent with that level of unemployment and that level of poverty.

It doesn’t make it any less real. It doesn’t make it any less of a challenge. But it is definitely something that there is a lot of room for improvement from all the health care providers here.

Brown: It does appear that a lot of the community’s health care institutions operate without a plan for coordinating services. What is the relationship among the providers?

Lee: It’s a collegial one. Obviously, there’s significant respect amongst the institutions. I have met with Mark (Pyle), David Ptaszek and Steve Wiggins individually, and we have a good relationship. There is … some benefit of us having the mayor and the county judge on the hospital board. They have their finger on the pulse of what’s going on with the health department and with Pennyroyal Mental Health, and they bring some cross coordination of that knowledge. But, I’d be the first to say, that can be improved.

A lot of our challenge the past couple years has been with the governor’s Medicaid managed-care program and a lot of the pressure to change being driven by the Affordable Care Act. … Mark, he is going full-out trying to establish the health department’s mission, and where it fits in with all the changes, and dealing with reimbursement challenges.

When I talk to David Ptaszek, he’s scrambling. He’s been trying to get his FQHC (Federally Qualified Health Care) going, trying to deal with Medicaid managed care, trying to get his veterans center going.

We’re dealing with the same things: reimbursement challenges, health-insurance-contracting challenges, Medicaid managed care and physician recruitment, all while trying to improve our quality and patient care and satisfaction. What we find is we’re going 10, 12 hours a day, all of us individually, dealing with that. It’s easy to say ‘When do we have time to all get together?’

That’s the challenge, we’re all so busy trying to react, and prepare for, and deal with the changes that are coming down. It is hard to find time to get together and coordinate on a community-wide health impact plan. We’ve made some efforts to do that. There is some coordination. Certainly, that is something that we want to get time to work on and improve.

I know David and Mark were sitting here, and Steve Wiggins, they would say the same thing. The relationships between our facilities are good, it’s just the challenges of the time to work on it. …

Brown: St. Luke has been struggling financially. Is there anything that Jennie Stuart has planned in the next year or two related to St. Luke?

Lee: Two members of our leadership team are on that board. That’s been consistent. We’ve had either physicians or providers or employees who have served on that board. Through the years, our hospital has continued to increase its support. We’re providing some annual financial assistance. I don’t mean to imply it’s a $100,000 or $200,000. I don’t mean to imply that we’re providing staffing positions. … We’ve always provided the building. We lease that for $1 a year to St. Luke, and the pathology and diagnostic imaging physicians have always provided significant free services. If one of those providers calls and says I need an MRI for this patient or a CT, 99 percent of the time we do that at no charge. We do provide a lot of financial support other than just the bricks and mortar. Actually, we’ve started providing some financial assistance to go toward utilities and things like that.

Everybody agrees that the concept of a free clinic is great. The challenge that the health department has, and that Pennyroyal Mental Health Center and Western State, and Jennie Stuart has is that, when we go into budget, we’re all having to look our service lines and say ‘Which ones are meeting community needs? Which ones are not?’ In some cases, we have to trim service lines or try to add new ones. We’re all so focused on controlling our internal costs. I’ve had some people suggest ‘Why doesn’t the hospital take over the free clinic and run it?’ But I mean, you can imagine the expense. That’s part of the reason they’re struggling. Unless you have volunteer providers, it would be incredibly expensive, several hundred thousand dollars a year to provide just the staffing, not to mention the supplies and everything else for a free clinic. It is a significant financial commitment to operate one of those.

Everybody agrees that it’s a fulfilling and important mission. It really is a star in the cap of our community that we have a free clinic, because most communities our size don’t. … We’re very fortunate and blessed to have that in Hopkinsville. The question that we haven’t come up with an answer to is how do we make it viable and how do we continue to make it something that can grow.

Hayes: Is the mission and business model of Jennie Stuart, as a nonprofit community hospital, ever in conflict with the work of its for-profit management company Quorum? How does the hospital board balance those competing interests?

Lee: Well, QHR (Quorum Health Resources) is a for-profit company, but their profit is strictly related to the management fee. QHR’s primary goal is to provide me and Sam Brown, who’s the CFO, and make sure the board is satisfied with the level of service we’re providing to the hospital. QHR as a for-profit company, their financial performance is not tied in any way to Jennie Stuart’s financial performance.

QHR’s longevity in this community as my employer is strictly tied to the board’s satisfaction and the board’s perception of the job Sam and I are doing as QHR’s representative. From my standpoint, and I think I’m very objective about this because 23 years of my career I was part of Jennie Stuart’s administration as a Jennie Stuart employee. I didn’t stop getting a Jennie Stuart paycheck until last January when I became the CEO … I think I can very fairly access both sides of it. I can tell you that I don’t spend one second of any day worrying about whether QHR is going to require me do something that is for the benefit of QHR and not Jennie Stuart because QHR’s success is strictly dependent on the job that we do and the board’s satisfaction with that job.

Our local board makes the ultimate decisions on what services we’re going to introduce, the broad scope mission vision values, broad scope policy statements, contracts. The board ultimately does have final authority on the direction and the strategic mission of the hospital. That’s really not determined by QHR in any way. I have never seen any conflict there.

The reason QHR was brought in, the hospital board had always taken it on itself to advertise and hire the administrator or the CEO. After long-time administrator Jim Walker retried, the board went through a very long and arduous process of getting the perfect candidate in the mid-90s and the gentleman came in and let’s just say … that it didn’t go well. That administrator left after a year and a half and that was traumatic experience for the board because they had felt really good about the decision they made and they thought they were doing the best in taking the hospital forward.

What the board realized was it is increasingly difficult for a community hospital board to make all those types of decisions. So that’s what was attractive about the QHR relationship, having a management fee they pay and it’s QHR’s responsibility to make sure they have a competent CEO and a competent CFO. ... There’s a lot less turmoil in that long, drawn-out, risky grinding work for the board when they have a management company that can efficiently and effectively do that because that’s a key component of QHR’s business, recruiting and placement, and that’s part of the value they bring to the table. That has provided a lot of security to the board and it’s worked very well.

Obviously Terry Peoples came in as the first CEO of that contract and I’m only the second CEO that QHR has had, so it’s been stable and it’s been a situation that’s worked out. Sam is only the second CFO and we’re talking 17 years now. So it’s been very stable and it’s been a relationship that’s worked well.