Big Business for Not-So-Big Hospitals

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April 2008

• 7 strategies for achieving the best possible financing.(Feature)
  April 1, 2008 ; McIntire, Mark

  Aging facilities and growing consumer expectations and competition continue to fuel increased capital spending by hospitals nationwide. To meet ongoing community needs, hospitals must invest in...
• Consumers want major changes in healthcare system.(Worth a Look)
  April 1, 2008

  A recent survey from the Deloitte Center for Health Solutions of Deloitte Consulting has found that consumers want a new and improved healthcare system that offers greater online connection to...
• Resort-area hospitals: dealing with an expanding (and contracting) community.(Q & A)(Interview)
  April 1, 2008

  While operating a hospital in a small community has its unique challenges, try operating a hospital in a small community that is a much larger community during certain parts of the year. That's...
• Searching for IT savings: hired guns need not apply; When resources are tight, look for technology that is designed for ease of use--and eliminate the need to hire an expensive specialist or consultant to solve the problem.
  April 1, 2008 ; Cohen, Steven M.

  System upgrades ... new regulations ... massive data uploads ... end-of-year reporting. These are just a few of the projects that typically require more man-hours than are available. Tight...

February 2008

• Aetna to pay physicians for online consultations.(Worth a Look)
  February 1, 2008

  Aetna announced in mid-December that it will reimburse physicians participating in most of Aetna's medical plans nationwide for web Visit consultations in more than 30 specialties, including...
• Building a new CAH using evidence-based design; When the design phase for North Valley Hospital, Whitefish, Mont., began a few years ago, the theme was clear: patients come first. The 82,000+ square-foot critical access hospital (CAH) cost slightly over $17 million to build and opened in March 2007.(Feature)(Reprint)
  February 1, 2008

  What Is Evidence-Based Design? The new North Valley Hospital was designed using the concepts of evidence-based design and the Planetree design philosophy, both of which focus on how the...
• Compensation growing faster for rural physician executives.(Worth a Look)
  February 1, 2008

  Compensation for rural physician executives increased over the last two years at twice the rate, 12.5 percent, of those in urban areas, according to the 2007 Physician Executive Compensation...
• Dividing departments conquers coding problems for Vermont CAH.(It Worked for Us)
  February 1, 2008

  Inaccurate coding is a problem common to many hospitals. What may not be so common is finding a solution that not only reduces labor costs and pleases the medical staff, but also puts the...
• Employee perspectives on hospital operations.
  February 1, 2008

  Hospital employees identify several key areas within hospital operations that need attention. Among these items are compensation, recognition for the work employees do, participation, and...
• Maine to launch statewide health information exchange.(Worth a Look)
  February 1, 2008

  More than $4 million has been raised to begin construction of the not-for-profit HealthInfoNet network, placing Maine among the first states in the nation to build and operate a statewide...
• Medical costs more burdensome for rural areas, South.(Worth a Look)
  February 1, 2008

  Communities where the cost of medical care is more of a burden are more likely to be in rural areas and in the South according to a recent study by the Commonwealth Fund. The study included...
• MS-DRG impact: more CAHs on the way?(Market Watch)(Reprint)
  February 1, 2008 ; Hochheiser, David

  We studied the impact of the new Medicare severity-adjusted diagnosis-related groups (MS-DRGs) on different hospital types. Our analysis shows that small, rural hospitals with less than 100...
• National employee satisfaction priority index.(Worth a Look)
  February 1, 2008

  Below are five areas in which hospitals have the greatest opportunity to enhance the employee work experience, according to a recent survey by Press Ganey Associates, Inc. The survey included...
• Pursuing a winning IT strategy.
  February 1, 2008 ; Rossi, Bob;Fincher, Niklaus;Vogel, Donna

  Small hospitals seeking to expand their IT investments are faced with a daunting requirement: producing impressive results with limited resources. Hesitant to part with scarce dollars and...

December 2007

• Community hospital lets patients calculate costs.(Worth a Look)
  December 1, 2007

  A new online service at a Hawaiian community hospital allows patients to calculate their out-of-pocket costs for medical procedures, according to an article in the Oct. 12 online edition of...
• Creative solutions: an unusual partnership results in a new hospital facility.(It Worked for Us)
  December 1, 2007 ; Owens, M. Barry

  What does a hospital and government agencies have in common with an Indian tribe? In Durango, Colo., plenty. That's where desire, cooperation, and maybe a miracle or two led to the 2006 opening...
• DRG blues: how to deal with the new system and come out ahead.(Feature)(Reprint)
  December 1, 2007 ; McCann, Dave

  The Centers for Medicare and Medicaid Services' new Medicare-severity diagnosis-related group system (MS-DRG) brings both good and bad news. Unfortunately, the good news is limited to large, ...
• FCC proposes rural telehealth pilot.(Worth a Look)
  December 1, 2007

  In November, Federal Communications Commission (FCC) Chairman Kevin J. Martin announced a comprehensive proposal to fund a $400 million rural healthcare pilot program (RHCPP) that would expand...
• S & P ratios for small hospitals rise modestly.(Worth a Look)
  December 1, 2007
• Stark Phase III: it's here, but is it going to help?(Q & A)(Interview)
  December 1, 2007

  In September, the Centers for Medicare and Medicaid Services (CMS) issued its third phase of the Stark Law regulations, first issued in 2001. (See the sidebar on page 11.) In this Q & A,...
• The pursuit of efficiency with scripting technologies.
  December 1, 2007 ; Cohen, Steven M.

  Everyone is talking about "living green"--taking whatever steps necessary to use less energy more efficiently. The idea of allocating resources and optimizing efficiencies certainly extends ...

October 2007

• CAHs receive guidance on necessary provider designation.(Worth a Look)
  October 1, 2007

  In a Sept. 7 letter to state survey and certification agencies, the Centers for Medicare and Medicaid Services has issued guidance on critical access hospital (CAH) relocation. The revised...
• CMS rate structure complicates community hospital's finances.(Worth a Look)
  October 1, 2007

  Medicaid's complicated rate structure may be the reason why a small community hospital in New York City turned what was initially a $2 million surplus in FY05 into a $6.2 million loss,...
• Discounted telecommunications services.(Bookmark this Resource)
  October 1, 2007

  Rural healthcare providers can receive discounts on telecommunications services and monthly Internet charges in a program offered by the Universal Service Administration Company. The program...
• EMRs worth the cost.(Worth a Look)
  October 1, 2007

  Electronic medical records were worth the expense at the University of Rochester Medical Center, Rochester, N.Y., according to a study published in the July issue of Journal of the American...
• Fitch-rated, not-for-profit hospitals continue strong profit levels.(Worth a Look)
  October 1, 2007

  Not-for-profit hospitals and healthcare systems in Fitch's portfolio 2006 are continuing at solid profitability levels supported by increasing revenues and improved operating controls. The data...
• Health IT: waiting for ROI? Be patient.(Healthcare Watch)(Reprint)
  October 1, 2007

  Investing in IT eventually pays off for hospitals, but realizing a ROI takes a while, according to a PricewaterhouseCoopers study. Researchers found that IT investments will eventually improve...
• Help with telehealth technologies.(Bookmark this Resource)
  October 1, 2007

  Telehealth Resource Centers assist healthcare providers and networks in the implementation of telehealth programs for rural and medically underserved areas and populations. There are five...
• IT best way to improve quality.(Worth a Look)
  October 1, 2007

  Healthcare leaders believe that accelerating the adoption of healthcare IT would be the most effective key strategy for improving quality in health care, according to a recent Commonwealth...
• Joint ventures and the OIG: guidance toward a more pleasant partnership.(Regulatory Comment)
  October 1, 2007 ; Alexander, Jim

  The development and management of hospital-physician joint ventures are near the top of most hospital CFO's list of what requires her or his attention in the days and months ahead. Would you...
• Rural hospitals in Hawaii to get more control.(Worth a Look)
  October 1, 2007

  Hawaii's rural hospitals will get more autonomy from the state's public hospital network with new legislation that sets up regional boards, according to Pacific Business News. Five regional ...
• Small and wired: how it works.(Q & A)(Interview)
  October 1, 2007

  St. Peter's Hospital in Helena, Mont., was named one of the most wired small and rural hospitals in the country in Hospital & Health Network's Most Wired Survey again this year. Here, Dan ...
• Staffing technology simplifies agency hiring: hiring temporary workers used to be a hassle for a two-hospital system in the Northwest. Thanks to an online system, those days are over. Costs saved come in handy, too.(It Worked for Us)(Reprint)
  October 1, 2007

  At one point, Tuality Healthcare, Hillsboro, Ore., was working with 40 staffing agencies to find replacements for clinical staff who called in sick or otherwise couldn't make it to work. During...
• The biggest IT mistakes made by small hospitals: since electronic medical records (EMRs) and computer provider order entry (CPOE) have become the ne plus ultra lately in healthcare IT, small hospitals have been spending millions of their scarce and hard-earned dollars on them--often, unwisely.(Feature)
  October 1, 2007 ; Ciotti, Vince;Schopp, Dick

  Below are the biggest mistakes we have seen small facilities make in acquiring hospital information systems (HIS), and the steps necessary to avoid repeating them. Wrong Size The...
• The quest for technology ROI: is the old standby financial analysis of net benefits divided by cost enough when examining technology ROI? Below are some additional factors that may weigh into this evaluation.
  October 1, 2007 ; Cohen, Steven M.

  ROI. Vendors and consultants frequently use this term to tout their solutions, but its full importance isn't always appreciated. A traditional ROI analysis examines the financial impact of...
• Tips to drive revenue from existing IT: when looking to optimize a hospital's technology resources, financial executives are advised to keep in mind the following strategies.(Financing the Future)
  October 1, 2007

  Solve Process Issues First Prior to applying technology to a process, it's vital to ensure the process itself is sound. For example, providing prescribers with automated order entry isn't...
• Use of selected EMR functionalities.(Worth a Look)
  October 1, 2007

August 2007

• Audit uncovers additional funds for rural Georgia hospitals.(Worth a Look)
  August 1, 2007

  More than 30 rural hospitals in Georgia received an additional $1.6 million from the federal government as a result of an audit of the hospitals' Medicare payments, according to The Blade Plus ...
• CAHs vs. non-CAHs: a comparison.(Healthcare Watch)
  August 1, 2007

  How do critical access hospitals (CAHs) compare to acute-care hospitals in terms of lengths of stay (LOS), costs, and mortality? The following analysis uses a proprietary database of inpatient...
• CMS pilots personal health plan project.(Worth a Look)
  August 1, 2007

  The Centers for Medicare & Medicaid Services (CMS) has initiated a pilot program for personal health records (PHRs) for Medicare users. The PHR will allow beneficiaries to become more involved ...
• Discounted drug program saves money.(Worth a Look)
  August 1, 2007

  A 2006 survey of pharmacy directors at rural hospitals that participate in the federal 340B Drug Pricing Program found that the average monthly savings is almost $19,700. Some hospitals...
• Heart attack death rates dismissed.(Worth a Look)
  August 1, 2007

  A study from the University of Iowa has found that rural hospitals in the state do not have higher death rates for heart attacks when compared to urban hospitals. The findings, which contradict...
• New HRSA recruitment bureau.(Bookmark This Resource)
  August 1, 2007

  The Health Resources and Services Administration (HRSA) has created the Bureau of Clinician Recruitment and Service, which consolidates existing HRSA scholarship and loan repayment programs...
• Newsletter on rural healthcare legislation.(Bookmark This Resource)
  August 1, 2007

  The National Rural Health Association has developed a semi-monthly electronic newsletter that highlights legislation affecting rural health care. The newsletter, called Amber Waves, features...
• Pondering the outsourcing option.(Reprint)
  August 1, 2007

  Your long-time revenue cycle director is retiring soon, and there's no one with the expertise or experience to take her place. Could outsourcing be the solution? That depends. Because there are...
• Pricing transparency: how can smaller hospitals get in the game?(Q & A)(Interview)
  August 1, 2007 ; Ankeny, Sue;Horras, Susan

  Small and rural providers may not yet be overloaded with questions about pricing transparency. But these providers will soon need to start coming up with some answers as consumer-driven health...
• Quality at smaller hospitals harder to rank.(Worth a Look)
  August 1, 2007

  Hospital size may affect the ability to accurately identify high-quality care in pay-for-performance programs, according to a policy brief by the Upper Midwest Rural Health Research Center. Key...
• Riding out the storm at Griffin Hospital.(It Worked for Us)(Reprint)
  August 1, 2007 ; Powanda, Bill

  How does a hospital that was once struggling to exist transform itself into a model of clinical and financial excellence, reaching various top performance lists? It recognizes trends, gathers...
• Rural enrollment in Medicare Advantage is growing ... but still low.(Worth a Look)(Reprint)
  August 1, 2007

  Enrollment in Medicare Advantage and other prepaid plans by type of plan Rural enrollment in Medicare Advantage plans has almost doubled--to more than 500,000--since 2005, according to...
• The CAH advantage: strategies for enhancing financial performance.(Feature)
  August 1, 2007 ; Fogel, Lawrence A.;Watt, Joseph M.

  While the critical access hospital (CAH) designation presents a significant payment opportunity for a small, rural hospital, many CAHs are not taking full advantage of it. Since creation...

April 2007

• Adapting to competition from specialty hospitals.(Data Snapshot)
  April 1, 2007
• Bush's FY08 budget is useful as worst-case scenario.(Regulatory Comment)
  April 1, 2007 ; Alexander, Jim

  A phrase often used to describe proposed federal budgets is "dead on arrival," and it appears to fit President Bush's budget for FY08. That's not to downplay the desires of the administration;...
• Community efforts attract physicians to rural Iowa.(Feature)
  April 1, 2007

  Skiff Medical Center, in Newton, Iowa, was facing some pretty big infrastructure problems in the early 1990s. Much of the 68-bed hospital's equipment was outdated, and it was losing patients to...
• Healthcare industry still struggling to attract/retain workers.(Worth a Look)
  April 1, 2007

  More than two-thirds of 110 healthcare providers surveyed about their recruiting efforts reported having difficulty retaining critical skill workers to a moderate or great extent. Across...
• HFMA's ANI 2007 provides practical tools and ideas for small and rural hospitals.(Bookmark This Resource)
  April 1, 2007

  HFMA's 2007 Annual National Institute (ANI) June 24-27 in San Diego offers you the opportunity to attend tool-driven educational sessions focusing on the issues concerning small and rural...
• IRS issues voluntary good practices for not-for-profits.(Worth a Look)
  April 1, 2007

  The Internal Revenue Service has outlined nine governance practices for tax-exempt organizations. The good practice guidelines are designed to help governing boards understand their roles and...
• Many rural hospitals now qualify for medication discounts.(Worth a Look)
  April 1, 2007

  A 2006 survey of pharmacy directors at rural hospitals has found that eligible hospitals are not participating in a discounted drug pricing program. The survey was conducted by the North...
• MD recruitment: getting it right.
  April 1, 2007 ; Skinner, Tim

  Dr. Bob, a third-year family practice resident, rushed into my office excited about the job offer he just received from a 30-bed hospital in northern Minnesota. The young physician and his wife...
• New study says hospitals can benefit from transparency.(Worth a Look)
  April 1, 2007

  Transparent price and quality information can offer hospitals and other providers feedback on how performance can be improved and ways to identify the most efficient and effective referrals,...
• Not enough medical students are choosing internal medicine.(Worth a Look)
  April 1, 2007

  Results of the 2007 National Resident Matching Program show that the number of medical students choosing internal medicine residencies (2,680) stayed about the same compared with 2006. The...
• One in five healthcare workers plan to quit.(Worth a Look)
  April 1, 2007

  Twenty-one percent of healthcare workers will leave their jobs this year, mainly for opportunities with better pay and career advancement, according to an online survey by Harris Interactive on...
• Optimizing resources for recruiting and retaining physicians.(Q & A)(Interview)
  April 1, 2007

  Consultant and author Samuel H. Steinberg. PhD, has more than 30 years of experience in the healthcare industry as a hospital CEO and consultant, working with health systems, academic and...
• The high cost of physician and nurse turnover.(Healthcare Watch)
  April 1, 2007 ; Faller, Marcia;Mosley, Kurt

  Large hospitals may be able to absorb the loss of a physician or nurse without feeling much pain, but smaller hospitals typically cannot. Indeed, the cost to small hospitals of physician or...

February 2007

• Borrowing a better credit rating.
  February 1, 2007 ; Green, Thomas R.

  Because of their size and service area, small and rural hospitals are often at a disadvantage for borrowing money. Fortunately, several credit enhancement options are available to reduce...
• Build a strong culture one thank you at a time.(Q & A)(Interview)
  February 1, 2007

  "Healthy financials are a by-product of a healthy culture in many ways," says Zani Weber, an executive coach with The Studer Group. "In my experience, culture outperforms strategy every time. ...
• CAHs report on medication errors.(Worth a Look)
  February 1, 2007

  A report on medication errors at critical access hospitals by the Nebraska Center for Rural Health has shown that errors affect patients for four main reasons: * A procedure/protocol is...
• Focused financing breathes new life into aging CAH.(It Worked for Us)
  February 1, 2007 ; Spidel, Alan J.

  Picture a hospital executive saying to his investment banker, "We have a 56-year-old facility, less than $3 million in cash, and we need $25 million to replace our hospital. Did I mention that...
• GPOs provide more than better prices.(Feature)
  February 1, 2007 ; Markoski, Dave

  Group purchasing organizations have been around for a long time. In fact, according to the Health Industry Group Purchasing Association, the first GPO began in 1910 in New York. Since then,...
• Increasing competition for providers seen as a top trend for 2007.(Worth a Look)
  February 1, 2007

  The rise of mini retail health clinics will mean more competition for physicians and hospitals this year, according to The Top Seven Health Industry Trends of '07, a recent report by the Health...
• Medicare cuts are not harming credit ratings, so far.(Worth a Look)
  February 1, 2007

  Initial cuts to Medicaid expenditures have not hurt the credit strength of not-for-profit acute care hospitals, according to a special report by Moody's Investors Services. The longer-term...
• Pay for performance affects rural providers differently.(Worth a Look)
  February 1, 2007

  Rural healthcare providers may be at a disadvantage when it comes to pay-for-performance initiatives, according to a recent report by the Upper Midwest Rural Health Research Center. The study...
• Private efforts and the drive to develop EHRs.(Regulatory Outlook)
  February 1, 2007 ; Alexander, Jim

  The pieces continue to fall into place for making the widespread use of electronic health records a reality in the "nearer" future. Last November, a handful of big businesses--Applied...