Hospital seeks to raise low satisfaction scores

Patients rank Springfield Regional near bottom in area.Merger, recession and surgical center among challenges.

The new Springfield Regional Medical Center faces a crucial year to regain community confidence eroded by a lengthy, painful consolidation during a prolonged economic recession.

Statistics in the Patient Satisfaction section of Medicare’s Hospital Compare website show that just 53 percent of patients give Springfield Regional a rating of 9 or 10 on a scale of 10. The report also says only 50 percent would definitely recommend the facility to others.

Those marks are 18 and 16 percent lower than the Ohio and national averages on the first measure, and 21 and 18 points off the state and national marks on the second.

A Springfield News-Sun comparison of Medicare’s 10 measures of patient satisfaction among 12 area hospitals found that Springfield regional ranked last in four measures and 11th on four more.

The period being measured — from April 2011 to March 2012 — was a time of transition for the hospital. For seven and a half months, Springfield Regional was in the former Community Hospital. The remaining four and a half were the first spent in the new building.

Still, the survey results represented an improvement for Springfield Regional, whose ratings appear to have bottomed out in 2009 and 2010.

The good news, say hospital administrators, is that when the Hospital Compare figures are released in mid-April this year, they will be up again.

Press-Ganey, which handles the surveys for Medicare, has told the hospital that for all of 2012, 63 percent of patients would give it a 9 or 10 rating.

Springfield Regional shared 2012 information on 8 of the 10 measures Medicare uses, showing improvements across the board.

That prompted Dr. Gary Hagens, Springfield Regional’s chief operating officer and vice president for medical affairs to say: “What I think you see is an organization that’s really committed to quality improvement.”

If the hospital had earned those numbers for the current reporting period, however, it would have remained 9th or below in six of those eight measures with the same 12-hospital comparison.

Hospital Compare collects data from 4,000 Medicare certified hospitals nationwide and is posted for consumers as an aid to comparing the quality of care. The website says the statistics help consumers make decisions and encourage hospitals to improve the quality of care they provide.

Underscoring the challenge for Springfield Regional were the strong patient satisfaction scores of the physician-owned Ohio Valley Surgical Hospital with which it competes for surgical cases.

Eighty-five percent of patients said they would give Ohio Valley a 9 or 10 and 88 percent said they definitely would recommend it to others, first on both scores in the comparison with other area hospitals.

Surgical hospitals are considered to have an advantage in such surveys because, not having an emergency room, they are better able to manage and control the cases they handle.

Still, Paul Hiltz, who after a brief stint as an interim executive was named Springfield Regional CEO, congratulated Ohio Valley.

“We’ve got to work on being excellent at what we’re doing regardless of what they do.”

Hiltz has set a goal of raising all patient satisfaction scores to at least 73 percent by year’s end.

“Patient satisfaction and patient care is the No. 1 job of this hospital,” said Hiltz. “It’s the measuring stick we’re going to use now.

“Our internal numbers show we’re making progress.”

Hagens said the hospital has fantastic physicians and can build on “pockets of excellence” that already exist, including cardiovascular surgery and cardiologists he said are regionally, if not nationally, known.

The hospital also can see hope in a return of its inpatient admissions, which dropped more than 1,500 from 2009 to 2010 to a total of 14,430. They rose to 15,492 last year, but will still need to climb by about 450 this year to return to 2009 levels.

Hiltz said that the number of inpatient stays in the hospital is up versus the first two months of last year.

Hiltz said Springfield Regional wants to improve in another area: Managing an emergency room he called “one of the busiest in the state” with about 70,000 visits a year.

The hospital fared somewhat better in comparison with other local emergency departments in the Hospital Compare statistics with ranks of 4, 5 and 6 in a News-Sun comparison of eight area hospitals with ERs.

But the average time spent before admission, 5 hours and 18 minutes, was sixth of eight local hospitals, 48 minutes longer than the Ohio average and 41 minutes longer than the national average reported by Medicare. The statistics measure the period from Jan. 1 to March 31, 2012, the first quarter Medicare measured.

“We’ve had some process issues we’ve made great progress on,” said Hiltz, who said bottlenecks in the flow of patients and work have been identified.

Because many uninsured people use the hospital emergency room for primary care needs, the hospital has set up a separate system for handling those cases and also is working with hospital employed physicians to make primary care doctors available for longer hours to keep the emergency room from being clogged with non-emergency cases.

That also should save the hospital money.

“We’re making progress,” said Hiltz, “but we’re not where we’re going to be yet.”

Beginning in May Springfield Regional will have its third emergency room physician staffing company in three years.

It’s a pattern some say mirrors a turnover of hospital executives that may have prevented a more solid relationship from developing between the community and Springfield Regional’s owner, Cincinnati-based Catholic Health Partners.

Since 2004, Springfield Regional has been led by Andy McCulloch, George Miller, Mark Wiener and now Hiltz. James Gravelle also served in an interim capacity.

Some sources told the News-Sun the executive turnover reflects the difficulty of of a position in which executives are called on to balance the needs of parent organization CHP with the needs of the local medical community.

Dr. Rick Nedelman, a surgeon and founder of the physician-owned surgical center, said a major problem in the relationship is the level of physician involvement and influence in decisions.

He said Springfield Regional is trying to move to a model of care in which physicians are hospital employees, and “the majority of physicians, medical and surgical, are unwilling to become employees of the hospital system.”

Nedelman said many critics of the physicians who founded the surgical center saw financial gain as the motivating force in their decision, but he said, “this is about a model of care delivery” in which physicians have a larger say.

No matter how people view that issue, it’s clear that during Springfield Regional’s struggles, the surgical hospital has flourished.

After performing 3,866 surgeries after opening in 2009, Ohio Valley jumped to 10,323 in 2010; 11,446 in 2011; and 12,004 last year. Of those, it averaged 750 inpatient stays in the past three years.

This makes Ohio Valley “one of the busiest of its kind in the Miami Valley,” said President Steve Eisentrager.

It also allowed it to open a second building last fall to house its Comprehensive Ortho/Spine and Diagnostic Center, adding spine surgery, imaging and physical therapy to its Springfield services.

At a time when Springfield Regional cut and consolidated its staff — moves that damaged morale and that surgical center promotional material says resulted in “many patients leaving for Dayton and Columbus hospitals” — the surgical hospital boasted of establishing new patient services to keep patients in Springfield and bringing back to town at least 25 nurses who had left to work elsewhere; and being named a top place to work.

If this presents a snapshot of the current health care picture, Dr. Alan Gabbard said a broader understanding requires a look into the past and the future.

During his 31 years practicing gastroenterology in Springfield, Gabbard served 17 years on the former Community Hospital’s board of directors, was vice president of its medical staff and left the medical executive committee of Springfield Regional in January.

During a process he said he’s been involved in since the beginning, he’s seen the local community:

• Agree after several failed attempts to merge its two hospitals.

• Conclude that trying to convert one of the old buildings “was not going to fly” in a new era of medicine.

• Learn from consultants that a new facility and merging was possible but the profit margin was going to be small, and

• Decide that “the only entity that could fund this venture and attempt to make a profit was CHP.”

Locating the hospital downtown took years longer than anybody anticipated, he said, forcing the hospitals to try to make ends meet.

That time cost money as the hospitals delayed merger because consultants said it would go much more smoothly if it happened in the neutral site of a new hospital.

That plan ran into the recession in which people lost their health insurance, increasing the burden the hospitals had for uncompensated care straining budgets, Gabbard said.

That led to the awkward and unplanned move to merge operations at the former Community Hospital before the new building opened, and from 2006 to 2007 slashing $18 million from its budget.

Gabbard said Springfield Regional then lost some of its more profitable surgical business when the physician-owned hospital opened, lessening its ability to deal with what he called “unsustainable losses.”

The oft-criticized former Springfield Regional CEO Wiener entered at that moment, and “from the time he came to the time he left, (operated in) this impossible situation,” Gabbard said.

“In the face of the worst economy in 50 years, in the face of a competing hospital, they built a new hospital facility, a gorgeous facility, and turned a profit,” Gabbard said.

Gabbard insists that what Wiener accomplished is remarkable.

Gabbard then addressed the future.

He said more change is likely to come under the Affordable Care Act, often called Obamacare, which Springfield Regional’s Hiltz sees as a boost to the CHP approach.

“The thinking is the state as well as the medical and commercial payers are going to want statewide networks” like CHP has developed, said Hiltz. “That’s a plus to our thinking” and would allow Springfield Regional to reap benefits.

Analysts say that the switch to using measures of quality care instead of quantity of care is considered likely to favor larger systems that eliminate unnecessary tests and procedures and control their costs.

Springfield Regional faces a more difficult task in increasing its surgery caseload to a level Gabbard says is necessary to make it financially healthy.

Gabbard, initially against the surgical center, said its success has earned a strong base of patients.

Coupled with the limited size of the Springfield market, he added, that’s likely to make it difficult for Springfield Regional to recruit new surgeons to increase its surgical business to the level he thinks CHP needs to improve its operating margin.

Without it, he said, “they have to run so lean that I’m not sure it’s sustainable.”

Gabbard said he sees three possibilities for the future relationship between Springfield Regional and Ohio Valley:

1. CHP tires of operating at so lean a margin and sells Springfield Regional, allowing someone else to buy it and the surgical hospital.

2. CHP buys the surgical hospital and recoups some of the income it needs.

3. The two hospitals carry on as is until a union is made desirable, either by the influence of Obamacare or the desire of the original physician investors to recoup their investments.

“The best option would be to have the hospital buy” Ohio Valley, said Gabbard.

“The best scenario for Springfield would be to have one large medical campus downtown without competing interests, with a community hospital, a boutique surgery hospital and a cancer center.”

He called that possibility “state of the art and ideal. No other community I know of has that has that kind of setup.”

Nedelman said Ohio Valley doctors “think we’re going to need to affiliate with a larger, stronger health care system for a variety of reasons.”

One may involve the likelihood that hospital-employed physicians are more likely to refer their patients to Springfield Regional for surgical procedures.

Nedelman said partnership is a different concept than ownership, and because the surgical hospital allows surgeons more autonomy, “We’re not looking to be bought out.”

Springfield Regional’s administration is talking in more conciliatory tones.

“We’re in a different place” in relationship to the surgical hospital,” said Springfield Regional’s Hagens, “and I believe some of the decisions made in the past wouldn’t be made now.”

“We’re approaching the future with an openness to collaboration and working closely with the physicians from Ohio Valley.”

Bryan Bucklew, president and CEO of the Greater Dayton Area Hospital Association, said the existence of Springfield Regional and a freestanding surgical hospital represents “a big challenge for Springfield,” but added that “what Springfield is experiencing, the Dayton market experienced five or six years ago.”

Bucklew said changing Medicare rates eventually made the freestanding hospitals less financially viable, and many of those hospitals “have figured out a way to connect with other partners.”

He said most believe the Affordable Care Act will have the same effect.

“Every situation’s unique,” he said, but in a time with so much uncertainty about the future of health care, many see advantages in in being part of a larger system.

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