Saturday, December 29, 2007

Special memories

Today the census in Community General’s licensed nursing home is in the single digits. Our census was 48 just 90 days ago when New York State announced it would provide the funding to help Community comply with the Berger Commission.

With the funding, Community and Van Duyn Home and Hospital were able to go forward with plans to downsize our combined nursing home capacity. On November 5 I announced specific dates for the closure of Community’s 50 nursing home beds. Our census had already started to fall – it was 41. By December 15, when we formally reported the 30-day closure plan, the census was 13. Today we have just seven residents.

Community has cooperated with the Berger Commission decisions, both in negotiations with New York State and with Onondaga County, Van Duyn's owner. I have written much about the Berger Commission and its impact on Community and Van Duyn in previous posts.[1]

The Berger Commission has attracted nationally attention, and the current issue of Modern Healthcare, reports:

One year after becoming law, New York’s landmark experiment in mandated hospital closures, mergers, and restructuring is proceeding as planned. In fact the majority of affected hospitals and nursing homes are meeting or exceeding the June 30, 2008 deadline, according to state Health Commissioner Richard Daines.
With Van Duyn, Community's mandate is to downsize nursing home beds and to coordinate medical planning. In association with Onondaga County we have responded directly.

1. Community has transferred residents from our sixth floor nursing home to Van Duyn and to other area residential health care facilities. This has been done gradually and smoothly with respect for patients and their families. There has been no negative impact on the area's nursing homes which collectively operate at about 97% occupancy. In addition to the closure of Community's 50 nursing home beds, Van Duyn plans to decertify another 13 beds next year.

2. This week Community and Onondaga County signed an agreement to form a joint planning company that will oversee and coordinate planning on the Community-Van Duyn shared medical campus. This agreement was reported last evening on WTVH-TV in Syracuse with speculation as to what such coordinated planning might mean. There are no specific plans for shared “food, laundry or and nursing facilities,” as reported. But the joint planning company, when it becomes operational next year, will look to improve clinical specialization and coordination and will seek opportunities for cost savings and medical campus development.

3. Finally, New York State has committed some $12.8 million to Community and Van Duyn. These funds will be used for capital improvements in Community’s medical-surgical areas and in Van Dun’s long term care service areas, as recommended by the Berger Commission. They will also help the to-be-formed joint company begin its coordinated planning process.

Despite this good news, the fact remains that 48 residents have been (and are being) relocated from Community to other facilities. In addition, some 60 full-time and part-time employees will no longer have jobs on Community’s sixth floor.

The loss of jobs has been (and is) a source of concern and upset within the hospital, as evidenced by SEIU1199's requests for the hospital to maintain these positions, despite the loss of work. Unfortunately, Community cannot afford to do this, as I explained in a letter to the labor union's officers on December 3.

Special thanks are due to our sixth floor management and employees for the professional and sensitive ways they have worked with residents during this disruptive and sometimes heart-wrenching process.

Two weeks ago, sixth floor residents received holiday tree ornaments as mementos of the time they have lived at Community. Employees visited former residents who are now at other nursing homes to give them the ornaments. It was a sensitive gesture, illustrative of the care and purpose with which employees (who are themselves affected by the sixth floor closure) have addressed the transition with residents.

Congratulations to Maureen Cerniglia, Community’s Director of Continuing Care and licensed nursing home administrator. After closure, she will become the licensed nursing home administrator at Van Duyn under the administration of County Executive-elect Joanie Mahoney.

Special thanks, also, to Joseph T. Barry, MD. Dr. Barry was recently honored as a member of the medical staff with the STAR award for his demonstration of “star” qualities (sensitivity, thoughtfulness appreciation respect). He has served as our sixth floor medical director for 19 years.

[1]A positive side to Berger compliance,” November 9, 2007; “When our sixth floor will close,” November 5, 2007; “State funds will help compliance with Berger Commission,” October 2, 2007; “No secrets,” August 12, 2007; “Today's news about the Berger Commission,” August 14, 2007; “What's up with the Berger Commission,” July 28, 2007; “Q&A on CGH and Van Duyn,” January 20, 2007; “What the Berger Commission said,” December 2, 2006; and “My testimony before the Senate Health Committee,” December 1, 2006.

New York hospitals rank 49th

Here’s a revealing note from the Healthcare Association of New York State (HANYS), posted yesterday on its website.

A recent HANYS analysis of hospital financial data found that more than half of…[New York] state’s hospitals lost money or recorded margins of less than 1% in 2006. A separate national study by the American Hospital Association (AHA) found that the average operating margin of New York’s hospitals ranked 49th in the nation in 2006, second only to Hawaii...

Weak hospital margins and losses are primarily attributable to governmental and private insurance reimbursement rates that are artificially low and in some instances more than a decade out of date. Perennial federal and state funding cuts, along with workforce shortages and rising costs for everything from blood products to liability insurance also exacerbate ongoing revenue challenges…

See my posting of two weeks ago about the shortfall in payments to Community General Hospital by Medicare.

Saturday, December 22, 2007

A responsibility & a privilege

Three years ago, at Christmas time, I wrote a brief letter to employees, following my rounds that morning.

"It's a holiday," I said, "and our patients need us."

I also compared the hospital to Robert Frost's definition of home, "where, when you go there, / They have to take you in."

What a responsibility we have, working in the hospital. And what a privilege too.

Happy holidays, everyone.

Sunday, December 16, 2007

Our wrong-side surgery

Recent news reports about wrong-site surgery at a Rhode Island Hospital generated coverage around the country, including here in Syracuse. Today the Post-Standard reported about a wrong-side surgery that occurred at Community General Hospital in 2004.

How could such a thing happen?

It’s the question we asked ourselves, as you can imagine, in the agonizing minutes, hours, and weeks following that day in 2004 when a surgeon performed an arthroscopy on the wrong knee of a patient here.

I learned about this medical error the morning it happened. Later that day I participated in a root cause analysis intended to identify factors that contributed to the error. Participating in the analysis were the surgeon, the operating room personnel, as well as key administrative and quality department staff.

I promptly apologized to the patient for the medical error. I also apologized to the surgeon because our safety processes did not help prevent the error that day.

This wasn’t a willful act. It was a mistake by human beings who are highly capable and who had the best of intentions. The complexity of modern medicine allows us to do much good for patients, but that very complexity can also introduce risk. Hospitals have established internal processes that are designed to reduce the risk of error, but our process failed us – and failed our patient – one day in 2004.

Our first step that day was the root cause analysis. But there were many more steps in the succeeding days and months, each one intended to help us better understand the error and better prevent a recurrence.
- We promptly reported our error to the State Health Department, as required by law. We continued reporting to the state over many months. We acknowledged our error, and we paid a fine.

- I contacted a hospital administrator who had experience with a wrong-site surgery. She helpfully shared with Community General the lessons from that hospital’s experience, including other sources for us to contact and process improvements they made.

- We requested help from the Joint Commission. Specifically we asked for an on-site review of our processes, starting with patient registration and continuing through the process of surgery.

- We visited a local manufacturer and met with the plant manager and a quality engineer to learn more about how industrial processes can reduce the risk of error.

- We hired an operating room nurse consultant (someone with experience in wrong-site surgery cases), who reviewed and helped us improve our processes.

- We made changes in our Universal Protocol, and they were accepted by the Department of Health.

- We re-trained all staff in the safety procedures required by the Universal Protocol, not only in the Operating Room but throughout the hospital.

- Each member of the Medical Staff individually endorsed the Universal Protocol process and committed to follow it.

- We conducted ongoing reviews of compliance with the Universal Protocol, and we audit procedures throughout the hospital to assure proper processes are followed. This surveillance is ongoing.

- We reported all our actions to the Quality Committee and to the Board of Directors. This reporting continues (as recently as our last meeting of the Quality Committee and the last Board meeting).
Because health care involves human beings, mistakes, regrettably, are possible. That’s why we rely on standardized processes that are followed by each member of the care team in a coordinated fashion in each and every case. This safeguards patients from error. But we know that systems too can fail, and the process of improving systems is ongoing.

We have done many things to address the situation that allowed a wrong-side surgery in 2004. But we have not closed the chapter on it. It remains a fresh lesson for all of us who work together each day in the interests of patient safety.

Saturday, December 15, 2007

The Medicare shortfall

I got a call this week from the office of Congressman Jim Walsh (NY-25). What, I was asked, does it cost for Community General Hospital to care for a Medicare patient? And how much do we get paid for that care? It’s an interesting question – and an interesting answer.

The average cost of care for each Medicare patient at CGH is $8,767. For that we are paid an average $6,612. That means our hospital loses $2,155 for each patient. And we take care of a lot of Medicare patients, some 4,600 a year.

How does a hospital make up such a loss? There are really only two sources : the payments we receive from commercial insurance companies and the funds donors give to the Community General Foundation. That’s a reason employers find their health insurance premiums so high each year. Part of their health insurance premium represents the extra amount it takes to help make up for shortfalls by government payers. It also explains why hospitals rely on charitable contributions.

Holiday lights

Thank you, Auxiliary to Community General Hospital, for the beautiful lights that decorate the trees in the park across from the entrances to Community General Hospital. And thank you for the splendid Holiday Lights on the Hill tree-lighting ceremony on December 5.

Saturday, December 1, 2007

For the United Way & CGH Employee Fund - Thank you!

My thanks to all who contributed to the CGH Employee Fund/ United Way Campaign. The campaign exceeded the 2007 goal by 8%!

Some $45,755 was raised in cash and pledges from employees, with help from retirees and volunteers.

Congratulations to Nancy Thompson, who chaired this year’s campaign with the help of her able committee, the leadership of the 14-person CGH Employee Community Service Fund. That's Nancy in the photo, more or less in the center of the photo. Others representing the Fund are, from left, Kristin Dombroske, Dan Cameron, Ken Redmore, Nancy, Maria Damiano, and me.

Each year the Employee Fund helps the United Way of CNY and raises funds that help members of the CGH family who may face unexpected personal financial hardship during the year.

Great work, all.