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Gunn: ‘encouraging trends’ at KershawHealth

Posted: January 17, 2014 4:42 p.m.
Updated: January 20, 2014 5:00 a.m.

While interim KershawHealth CEO Terry Gunn didn’t have all good news for the healthcare organization’s board of trustees at its Jan. 13 meeting, he did describe much of what he’s seeing as “encouraging trends.”

One of Gunns’ highlights in his CEO Report to the board is that during the first quarter of the current fiscal year -- October through December -- 78 percent of KershawHealth’s admissions came through the emergency department. He said that trend seemed to hold steady during the first two weeks of January.

“That definitely creates some implications to me,” Gunn said, “that we make sure we really focus on our emergency room operations -- that it’s smooth, that it’s efficient, it’s flowing and providing a good experience for our patients as they come in there.”

He also reported that the first quarter saw a 2.7 percent uptick in surgeries compared to the prior fiscal year’s first quarter. At past meetings, KershawHealth Executive Vice President and COO/CFO Mike Bunch has reported significant drops in surgical volumes due to both turnover in some specialties and a national trend away from elective surgeries.

“That’s encouraging to see, that our surgical volume is continuing to increase and recover,” Gunn said.

He pointed out, however, that the first two weeks of January included two weekends. He said it is hard to get a good idea of a trend for surgeries because the healthcare system doesn’t operate a lot on the weekends except for emergencies.

“But, some encouraging news there. We’d love to see that trend continue to increase as we move forward,” he said.

Gunn reported on what he had seen during the first two weeks of the new year, noting that most volumes appear to be holding steady from the first quarter. That includes admissions, which were down 9 percent during the first quarter of the current fiscal year compared to the same period in the prior year, which he said was actually better than what administrators had seen in the past.

“It is a little early in the year, and we did have kind of a unique situation where we’ve had two weekends (in January) hitting us this early in the early part of the month,” Gunn said. “(That’s) certainly not enough to make a lot of judgment calls on, but it looks like we’re trending about where we were during the first quarter of the year. A little bit better than it has been, but not quite where we’re hoping it would be.”

Gunn said emergency department visits are running 16 percent below prior year so far in January, close to the first quarter being down 15 percent. However, he said the volume of patients admitted to the hospital from the emergency department was 1 percent above prior year for January so far.

Gunn informed trustees he was about to lead “very detailed” operation reviews of KershawHealth’s departments.

“Mike, the leadership team and I will be sitting down with the leadership of each department and really looking at their volumes -- what’s driving those volumes and then making sure we’re setting an expectation of managing our expenses and operations for the volume that we’re seeing -- that we’re not holding on to wishes and hopes,” Gunn said. “That, where things are growing, we’re matching that with our resources as well, but, also, those that are not growing as fast, that we’re stewards of the resources that we have and making adjustments where we need to.”

Gunn also updated the board on topics of interest to the healthcare industry coming up in the General Assembly’s 2014 session. Most notably, he said, will be scrutiny of the now defunct certificate of needs program in the S.C. Department of Health and Environmental Control (DHEC), calling it the legislature’s “hot topic” of the year. DHEC suspended the program for 12 months following Gov. Nikki Haley’s veto of $1.7 million needed for its funding. The S.C. Supreme Court has agreed to hear a challenge of the veto, with oral arguments possibly coming in March.

Gunn said he expects a “strong flurry of activity” from the General Assembly about the certificate of need program, and will be staying in touch with the S.C. Hospital Association on that issue.

“That will definitely impact all of us. Clearly, that’s going to define how healthcare continues to develop across the state and within our county,” he said.

Answering a question from Trustee Eric Boland on another matter, Gunn said he sat in on the emergency department’s triage unit for three hours on a recent evening.

“It’s a pretty good system of assessing where people are -- the severity of their illness. What a lot of other emergency rooms are doing … some are going into what’s called a fast track,” Gunn said, with either nurse practitioners or physician assistants separating out patients by need.

Gunn said he would continue to talk with Emergency Department Medical Director Dr. Lorone Washington about the triage process.

Also during the Jan. 13 meeting, Board Vice Chair Dr. Tallulah Holmstrom reported on activity from the board’s quality committee. In addition to providing the board with system-wide performance improvement goals for 2014, Holmstrom also updated trustees on Fiscal Year 2013 performance improvement indicators.  She said almost every metric saw improvement, especially highlighting readmissions.

“As many of you know, those readmissions factor in substantially with respect to the fiscal performance of the hospital. Many conditions aren’t reimbursed if readmitted within 30 days. We’ve made, internally, great strides,” Holmstrom said.

KershawHealth tracks three readmission indicators: those of patients originally admitted for heart attacks, heart failures and pneumonia. Holmstrom reported that readmissions rates were well below the healthcare organization’s targets in all three areas.

In regards to 2014 goals, there are some where KershawHealth already reached 100 percent in 2013.

“A lot of times, people think these 100 percent compliance things are elusive,” Holmstrom said.

She said there are many institutions in other industries that meet 100 percent compliance on its goals on a routine basis.

“There’s no reason why healthcare institutions can’t do that. The only way, really, to do it, is to look at your systems and decrease the opportunity for variance,” Holmstrom said. “You increase the opportunity for variance and you actually, substantially, poise yourself to have a quality problem.”

At the end of her presentation, Holmstrom said KershawHealth is setting its goals and targets based on consumer quality measures.

“When we utilize the hospital -- all of us have utilized the hospital as consumers, not just serving it as board members or as administrators or senior leaders … we want to get our money’s worth,” Holmstrom said. “Likewise, when we’re delivering a product, we really want it to be the best product we can deliver. Quality is getting more and more in line with the financial performance of hospitals.”

She encouraged her fellow trustees to understand the metrics involved, in order to have administrators set expectations to meet those goals.

“Quality won’t improve until we drive it from these chairs,” Holmstrom concluded.

In other business:

• Responding to a report from its CEO Search Committee, trustees discussed possibly suspending the search for a permanent CEO for 90 days, allowing the board time to better define KershawHealth’s strategic direction. The committee will make a recommendation to the full board at its next meeting.

• Trustee Bobby Jones reported on Gunn’s appearance at a recent meeting of the KershawHealth Board of Visitors.

• At Chair Karen Eckford’s request, Gunn reported on an a board education item to be led by members of Nexsen Pruet, KershawHealth’s legal counsel, on strategic issues and what other healthcare systems are doing in that regard. The education session will take place during an upcoming board retreat. Gunn said S.C. Press Association Executive Director Bill Rogers will also appear at the retreat to educate trustees on the S.C. Freedom of Information Act.

• During her report, Eckford alerted trustees to the fact that she and Gunn will appear before Kershaw County Council at its next meeting.

• During trustee comments, Eckford mentioned that many people attending a recent legislative briefing at The ALPHA Center asked her questions about KershawHealth, leaving her “very impressed with how important the healthcare system is to everyone” in the county.

• Trustees met in executive to discuss and vote on a medical staff report; conduct a review of feasibility, planning, marketing information/evaluation/materials containing references to competitive information or evaluation; and three contractual matters regarding general surgery, the emergency department and pediatric hospitalist coverage. The board took no action following the executive session.

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