Tulare Regional Medical Center

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TULARE REGIONAL MEDICAL CENTER Comprehensive , Quality and Innovative Care in your backyard

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Tulare Regional Medical Center. C omprehensive, Q uality and I nnovative Care in your backyard …. Background. 112 Bed Acute Care Hospital Serving approximately 170,000 people in the Tulare County and its surrounding area Provides emergency, diagnostic, elective and surgical care - PowerPoint PPT Presentation

Transcript of Tulare Regional Medical Center

Page 1: Tulare  Regional Medical Center

TULARE REGIONAL MEDICAL CENTER

Comprehensive, Quality and Innovative Care in your backyard…

Page 2: Tulare  Regional Medical Center

Background 112 Bed Acute

Care Hospital Serving

approximately 170,000 people in the Tulare County and its surrounding area

Provides emergency, diagnostic, elective and surgical care

Operates 4 rural health clinics, 1 wellness center

Future expansion will include a new medical tower, an FQHC, and an additional rural health clinic

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TRMC's Current Situation: SWOT Analysis

-Low market share in desirable service

lines and payer categories

-Loss of insured patients to other

hospitals-Dependency on Medi-Cal patient

base-Difficulty

attracting and retaining

physicians-High cost

structure; low revenue

-Financial burden of the uninsured and

underinsured

-Physician recruitment and

retention-Quality

improvement of health care

services-Performance improvement initiatives for

improved -charge capture, reduced

readmissions rates, and

reduced bad debt-Improve hospital

reputation and image

-Improve market share in specific

service lines

-Competition from surrounding

facilities and hospitals

-Defection of key physicians,

unsuccessful recruitment-Potential

resistance of medical staff to

change-Potential for poor financial performance threatening expansion

-Continuation of negative public

image

STRENGTHS

OPPORTUNITIES

WEAKNESSES

THREATS

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Financial Snapshot

2006-2007 2007-2008 2008-2009 2009-2010 2010-2011Gross patient Revenue 147,933,171$ 169,524,455$ 237,528,661$ 253,412,890$ 267,526,211$

Provision for bad debt 5,797,842$ 7,242,659$ 9,767,597$ 13,156,331$ $16,851,090Total contractual adj. 84,929,348$ 99,371,655$ 142,437,679$ 155,440,984$ 159,627,809$

DSH funds ($985,965) ($5,291,579)Charity other 900,995$ 1,391,501$ 1,366,276$ 5,468,836$ 6,754,192$

All other deductions 13,550,074$ 7,438,460$ 10,352,541$ Total deductions from

revenue 91,628,185$ 108,005,815$ 166,135,661$ 181,504,611$ $188,294,053Capitation premium revenue $112,004Net Patient Revenue 56,304,986$ 61,518,640$ 71,393,000$ 71,908,279$ 79,344,162$ Other operating revenue 617,025$ 766,842$ 673,721$ 2,744,238$ 1,878,170$

Total operating expenses 60,696,426$ 65,062,641$ 72,634,498$ 72,849,437$ 78,074,747$ Net from operations ($3,774,415) ($2,777,159) ($567,777) 1,803,080$ 3,147,585$ Non-operating revenue 4,874,867$ 4,566,523$ 9,640,063$ 12,790,190$ 13,897,152$

Non-operating expenses 604,776$ 48,748$ 3,933,781$ 4,477,770$ 3,872,312$ Net Income 495,676$ 1,740,616$ 5,138,505$ 10,115,500$ 13,172,425$

Source: CA OSHPD

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Strategic Plan Overview

• Performance Improvement Initiativeso Clinical processeso Financial processes

• Physician Recruitment and Community Development

• “Be Healthy Tulare” Marketing Campaign

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Performance Improvement Initiative

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Performance Improvement Initiatives Two performance improvement initiatives

for both clinical and financial processes Focus clinical QI initiative on the following

areas: Readmissions:

Heart attack- 19.8% Heart failure- 27.3% Pneumonia- 21.8%

TRMC is not be paid for episodes of care resulting from readmission within 30 days

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Performance Improvement Initiatives Poor quality of care scores will soon have

a financial impact on TRMC Starting in October 2012, Medicare’s

Value-Base Purchasing will withhold 1-2% of TRMC payment

Will track and reward performance based on: 12 process of care measurements 8 patient satisfaction scores from HCAHPS 30-day mortality rates 8 hospital acquired conditions

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Financial Process Improvement Critically important to address weakness in

financial processes now before the payment environment changes Disproportionate Share Hospital(DSH) fund

payments will be gradually decreasing due to ACA from 2014-2020 need to ensure financial viability without additional  payments

Three areas of financial management that need to be closely monitored and actively improved in order to retain financial stability: Occupancy Rate Bad Debt Rate Days in Accounts Receivable

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Change due to increased number of licensed acute beds

Financial Process Improvement

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Financial Process Improvement

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Fiscal Year

Financial Process Improvement

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Physician Recruitment & Community Development

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Physician Recruitment and Community Development Challenges:

• TRMC in rural, lower income area - presents challenge to physician recruitment

• 25 admitters account for 87% of all referrals, leaving TRMC vulnerable to change

o Areas of particular concern - Cardiology, Ob/Gyn, Family Practice, Orthopedic Surgery

o Revenue at risk at minimum $16 million• In Summary - Physician recruitment needs to be

addressed and relationships with referring physicians need to be fostered

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Solution: Immediate - Use NHSC loan forgiveness

programs as a draw for primary care providers

Long Term - Reorient physician recruiting efforts towards a community development approach

Physician Recruitment and Community Development

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1) Immediate - Use NHSC loan forgiveness programs as a draw for primary care providers

• 4 Rural Health Centers and Future FQHC are eligible under National Health Services Corps Loan Forgiveness Program

• Notify current staff of eligiblity to apply for loan repayment assistance.

• Inform primary care providers when interviewing them for positions that TRMC site is NHSC-approved and therefore they may be eligible to apply for loan repayment if they accept your open position.

• Utilize NHSC Recruitment Site to alert prospective and current Corps members to TRMC open positions.

• ACA expands funding for FQHCs and the NHSC program - this opportunity is growing

Physician Recruitment and Community Development

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2) Long Term - Reorient physician recruiting efforts towards a community development approach

• Modeled after a successful rural recruitment program in Arkansas funded by RWJF

• Combines traditional recruiting/retention and community developmento Mobilize community members; with long-term

goal to develop community into more attractive place for providers

• In RWJF funded pilot, average recruitment fees with this approach were $18,750 per provider – our projection is approximately $30,000 per provider due to CA labor costs

Physician Recruitment and Community Development

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Physician Recruitment and Community Development Recruiter Position:• Works with residents/primary care providers/health care facilities

to design and implement community improvements that make the area more attractive to new and existing providers

• Builds relationships with local health care providers and residents and works to unite them into action groups

• Provides technical assistance to enhance local capacity to self-assess needs and map resources

• Informs community about alternative solutions to increasing access to primary care, such as use of nonphysician professionals (nurse practitioners and physician assistants)

• Assists in developing grant proposals to bring needed resources to the community

• Nurtures new providers to ease their transition into their new community

• Links new providers with resources to improve practice retention.

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One more thing… Marketing

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A reminder of what we are facing…• Hospital’s historical reputation and public

perception and the continuation of that negative public image

• Low market share in desirable service lines and payer categories

• Growing competition with other regional providers and the need to differentiate

• Little philanthropic support from the community

• Growing need for chronic disease management and strategies to address obesity

Marketing Campaign

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Be Healthy Tulare!

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The Campaign AIMS to… Revitalize TRMC’s public image as a leader in

the delivery of healthcare in the community by highlighting recent performance improvement work and addressing drivers of health in the Tulare community

Advance re-branding of TRMC’s approach to healthcare (Emphasis on Prevention/Wellness and Quality)

Enhance TRMC’s visibility within and outside of the county

Improve community goodwill/customer loyalty Position TRMC as the principal partner in

advancing the total health of the communities it serves

“Be Healthy Tulare!” Marketing Campaign

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Identifying our approach…

“Be Healthy Tulare!” Marketing Campaign

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Strategic Focus Areas

“Be Healthy Tulare!” Marketing Campaign

CareDeliveryWorkforce WellnessCommunity Wellness

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Care Delivery “Comprehensive, Quality and Innovative

Care in your backyard…” is the key message Heavily market Maternal and Child Health

services Focus on pregnant women Aggressively capture stories and share

Highlight recent performance improvement initiatives Cardiac and Respiratory care

Share patient stories- videos are extremely effective

Key Message: Show the community we are the leading healthcare provider in the region

“Be Healthy Tulare!” Marketing Campaign

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Workforce Wellness Internally-focused campaign to motivate TRMC

employees and physicians to be “healthy eating, acting living” role models in their community

Explore possibilities of extending Evolution Fitness and Wellness Center membership to TRMC staff, if not done already

Quarterly wellness event – “Get-Fit Challenge” Capture the experience and share

Key Message: TRMC’s commitment to health care is not limited only to its patients

“Be Healthy Tulare!” Marketing Campaign

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Community Wellness Campaign: Investment and/or development of local healthy

eating, active living initiatives ID and collaborate with local community partners (e.g.

schools) Targeted Employee and Community

Engagement Targeted community service activities with

TRMC Senior Leadership and community partners (year-long projects)

Employee-driven community service projects Retired Physician Program (Transition to Public

Health Wellness Advocates) Key Message: Demonstrate TRMC’s

commitment to the total health of the communities it serves

“Be Healthy Tulare!” Marketing Campaign

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Graphic depicting Marketing Strategy Overview

“Be Healthy Tulare!” Marketing Campaign

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Strategic Plan Summary

Ongoing Main Issues Tackled BenefitsPerformance Improvement

Quality; Financial Stability

Increased Net Income; Financial Stability

Marketing Campaign Public Image; Visibility Improved reputation; customer loyalty; community presence

Long-Term Main Issues Tackled BenefitsReorient physician recruiting efforts towards a community development approach

Physician Recruitment and Retention

Strengthened referral network; community capacity development

Short-Term Main Issues Tackled BenefitsNHSC loan forgiveness programs

Sustainable Physician Recruitment

Strong physician recruiting tool

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Appendix 1: Value-Based Purchasing

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Appendix 2: Revenue at Risk Revenue at Risk

Net Patient Revenue

High Estimate (87% referrals)

Low Estimate (21% referrals)

$79,344,162.00 $69,029,420.94 $16,662,274.02

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Appendix 3: Recruiting BudgetProjected Program Budget