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KH board approves strategic plan

Seeks ‘strategic partnerships’ for Burndale Plaza, Elgin ‘performance health centers,’ more

Posted: April 29, 2014 4:57 p.m.
Updated: April 30, 2014 5:00 a.m.

KershawHealth hopes to at least mitigate a potential $32 million loss by 2018 through a strategic plan unanimously adopted by the KershawHealth Board of Trustees during its meeting Monday night. The plan focuses on strengthening existing healthcare services, adding new facilities adjacent to the Elgin Outpatient/Urgent Care Center and transforming Burndale Plaza.

The plan’s success hinges on forming strategic partnerships with physicians and other healthcare organizations to both provide those services and assist in funding their operations. The plan does not include cost or revenue projects, nor specifics on with whom KershawHealth might partner. It also does not call for any cuts in existing services.

The plan recognizes that the healthcare industry is moving from a hospital-centric to a patient-centric model focusing more on quality outcomes than the services provided. It also recognizes that, in addition to reduced governmental and commercial insurance reimbursements, factors impacting KershawHealth’s future success include an aging population, shifting physician employment patterns and a transition from primarily inpatient to outpatient services, among others.

The plan includes a number of development priorities: orthopedics, the emergency department and EMS, surgery, cardiology, women’s and children’s services, outpatient services, oncology and Karesh Long Term Care.

During an in-depth interview early Tuesday morning, Board Chair Karen Eckford and interim CEO Terry Gunn confirmed that, when it comes to strategic partnerships, nothing is off the table. In a statement released to the media Monday night, Eckford said some of those opportunities “might include leveraging local ownership” of KershawHealth.

“Wherever the board decides to go, based on what options are available -- and they are numerous … I think it’s important for us to be able to maintain the community feel of the hospital,” Eckford said Tuesday. “At whatever point, under whatever scenario, we find what I would call a partner (and) that they be closely aligned with our vision -- that there be, at some level, community ownership, partnership, participation and input.”

Eckford said stakeholders in the community said that “while they want to do whatever’s necessary to protect this quality healthcare facility in our community,” they also want to have at least some sense of ownership of the healthcare system.

“We’re open to whatever makes sense as long as it’s in keeping with the mission of the hospital and the orderly development of healthcare services for the community,” Gunn said.

Orthopedics is the top priority identified in the strategic plan. One of the steps for growing orthopedics at KershawHealth is to develop, through a joint venture, an ambulatory surgery center in Elgin. Another strategic partnership could, as an example, help bring in new orthopedic surgeons to perform those surgeries. The goal would be to create a “seamless, well-integrated service line,” Gunn said, similar to a partnership set to launch soon with TeamHealth in the emergency department.

“You can then go to the other end of the scale and we’re open to considering those opportunities as well that would include a strategic partnership for the entire healthcare system. So, when you talk about that, it doesn’t mean what it used to mean, where you just sell the hospital. It’s a whole lot more complex,” he said.

Gunn said that, based on stakeholder feedback, the board and administration will consider larger partnership and merger options, because of the economies of scale involved and best practices those partners have seen.

“And access to capital, because, clearly, we can’t implement this plan for free. It would take some additional capital to pull this off,” Gunn said. “What we heard was focus less on … who owns what and trying to preserve this exclusivity within the confines of Kershaw County, but protect our healthcare, make sure that we’ve got access throughout the community.”

Gunn said KershawHealth shouldn’t have to cut services to make this work. He said that, despite March being another month of losses ($266,000 in operating losses), the board and administration are “good stewards” of KershawHealth’s resources, especially where expenses are concerned.

“We have been wise with our supplies expensed utilization, which continues to go down, thanks in no small part to our relationship with Palmetto Health and Greenville Health systems with the purchasing consortium,” Gunn said.

He said salary expenses have also continued to decline, primarily due to attrition, but also -- as Eckford pointed out -- more efficient staff scheduling. Gunn said the plan assumes a continuation of managing those resources effectively.

“While it may look like it’s a lot of new development,” he said, “(it’s) really … taking what we provide today and busting it out of the walls of the hospital and getting it out where people live and work so that it’s convenient, done in an excellent way and centered around where patients are with what they need at that given time.”

That is one of the many ways the strategic plan hopes to circumvent a growing trend: Kershaw County residents going out of the county to receive healthcare services. For example, the plan notes that 70 percent of babies born to Kershaw County residents are not born in Kershaw County.

To deal with that, the plan proposes, among other steps, to recruit at least two additional OB/GYN physicians and create a strategic partnership to develop a comprehensive outpatient women’s center at Burndale to include physician offices, women’s imaging center, educational space and something called a “performance health center,” which Gunn explained later in the discussion.

He said that by making services available where people are is key to reversing that and other “out-migration” trends. Gunn said KershawHealth has an outstanding medical staff with “virtually every specialty” represented that is “absolutely 100 percent committed to patient care.” He also said patients should not have to drive to “just one spot” to get the care they need.

“It’s to make sure it’s accessible, available and done in a very high quality way,” Gunn said, so that they cut that migration of patients “off at the pass.”

Gunn said transforming Burndale Plaza would entail completely replacing the buildings that are there now.

“We kind of view it as an opportunity to reestablish another front door to the hospital and health system and to do it in a way that’s top quality to house all the services we want to put there and make it a significant impact on the community,” Gunn said.

A separate part of the plan suggests developing an urgent care center at Burndale, similar to the one in Elgin.

Elgin itself would see a new facility built adjacent to the current center, in the form of one of the aforementioned “performance health centers” and ambulatory surgery center. Gunn and Eckford noted that KershawHealth already owns additional land where the Elgin Outpatient/Urgent Care Center is located.

“So much has already been developed there,” Gunn said. “The idea here would be to expand at that site and do the surgery center … on that property and really integrating all the care that’s out there on that campus from urgent care to physician services to the surgery center.”

He said the term “performance health” replaces the concept of “wellness.”

“When we talk about performance, it’s ‘how do I improve or increase my performance in whatever I do on a daily basis.’ Usually, that relates back to something physical. If you think all of life is about performance, whether it’s in our work, in our hobbies, in our play, in our relationships with our family -- we want to help people perform at their best potential, at their peak performance in all of those activities,” Gunn said.

He added that children, too, would benefit from that model as they play sports and pursue academic excellence.

Eckford said work done by previous KershawHealth administrations and boards laid the groundwork for the Elgin expansion, with some infrastructure already in place to do so.

In addition to the performance health centers and ambulatory surgery center, the plan outlines establishing an orthopedic and sports medicine “center of excellence” and recruiting additional orthopedic surgeons to match market demand.

 “It has to do with my knee, my hip, my shoulder, my ability to be mobile,” Eckford said for emphasis. “We have excellent orthopedic specialists in our community. There is a perception that better quality care (for all lines of service) can be received elsewhere and we have board certified (and) double board certified, in some cases, physicians who have done cutting edge (work). With an aging population, I think orthopedics is going to be one of those (lines) because, based on healthcare … technology … early intervention, people are being able to stay active longer in life and we want to be able to ensure that our performance level remains at where we can continue to do.”

“I don’t want to be crass about this,” Gunn added, “but you’ve got something that’s really excellent. We’ve got … (and are) recruiting outstanding physicians in orthopedics and sports medicine. To back it up with the therapies (and) diagnostics services, surgical capacity … when I saw all those pieces coming together, I said, ‘Why in the world would you want to go to Charlotte or Columbia for that kind of service when you can get it right here.’ If we can integrate all that and make the experience seamless, consistent and high quality each and every time, you’d be a fool to go out of town.”

Eckford went back to the perception some people have that KershawHealth is somehow inferior to facilities outside the community. She wants to change that.

“We have to do a good job of helping our community understand the reality and change that perception,” she said. “You only get one chance of making a good impression. I think what happened is, over the course of time, the word has just gotten out that it is an inferior -- and I hate to use that word because it’s so negative -- but it’s a ‘less than’ what’s available in the Midlands, and it’s just not true. I think our job is to help our public truly understand what a valuable asset and the quality of care (we have).”

Other parts of the plan include:

• Matching EMS services to existing funding by making sure a 12-minute standard response time radius between EMS stations does not overlap nor go out of county. “I’m sympathetic to the needs of other counties, but that’s their job to figure out how to serve that, not ours,” Gunn said.

• Identifying a full-time ENT physician for coverage focused on KershawHealth. Gunn said that may be part of what goes into creating one of the performance health centers.

• Correcting “alignment issues” and creating a strategic partnership to create a comprehensive cardiac service … line.” Gunn said that is in response to another form of out-migration where physicians of a local cardiac office are now part of a large group out of Columbia. This part of the plan has yet to be fully developed, according to Gunn.

• A statement that OB/GYN recruiting has not been “aggressive.” Gunn and KershawHealth Vice President for Marketing and Community Development Joseph Bruce, who was in on Tuesday’s interview, said KershawHealth now has half the OB/GYN physicians it did three years ago. Instead of 70 percent of babies being delivered elsewhere, Gunn said that if there were two more physicians, perhaps 60 percent would be born at KershawHealth.

• To further strengthen outpatient services, the plan looks to recruit more primary and specialty care physicians and build on the LiveWell Kershaw’s initiative to extend care into the community.

• Oncology could be expanded to include radiation therapy through a partnership. Another possibility is to form a joint venture with a regional cancer center.

• HomeHealth and Hospice -- the plan recognizes extreme competition in both arena, but especially hospice. Again, some type of partnership may help KershawHealth compete with more than 30 other hospice providers in the county.

• Possibly moving Karesh Long Term Care to the old Pine Tree Hill School property. Gunn said the old school buildings would be replaced by a totally new facility. There is also a chance KershawHealth would expand into the assisted and independent living business through one or more strategic partnerships.

Part of the plan also focused on transforming KershawHealth’s culture.

Gunn said that starts now with sharing the strategic plan with the employees -- and celebrating their work when it comes to meeting high quality patient outcomes.

“As we do that, the basic facts will drive everything else. We are among the largest employers in the county which means the people that take care of you each and every day are your neighbors, people you pass on the street and nobody wants to let their family and friends or community down,” Gunn said. “We want to make sure they have the facilities, the tools, support, training and resources to do that excellent job. My hope, then, is that will be recognized throughout the community. It’s unfortunate when some people choose to tear down a local organization; it’s even more tragic that it’s an organization that’s employing the very people that live in this community.

“My hope is that some of that recreational spreading of dissatisfaction will cease, especially since it’s so unfounded, and people will gravitate to a sense of pride about what we do, where we’re going, not only as an organization, but as a community.”

Eckford and Gunn pointed out that, as KershawHealth-owned facilities become part of joint ventures, they will become tax-paying properties where they weren’t before. That, Eckford said, adds to the tax base, producing a win-win situation.

Ultimately, Gunn said, scaling back services in order to save money -- “saving your way to prosperity,” as he put it -- would not have benefited the community. Instead, he said, the new strategic plan continues to manage expenses responsibly while having a vision to provide comprehensive quality care for the county’s citizens.

“It really doesn’t matter who owns the bricks and mortar,” Gunn said, “but that we … choose to go down that positive path.”

In Monday night’s press release, Kershaw County Council Chairman Gene Wise said he is fully behind the plan for several reasons.

“First, it is solidly grounded in sound business principles, which I especially appreciate as a businessman myself,” Wise said. “Second, this plan is realistic about the critical need for strategic partnerships to gain access to capital. Finally, the economic and quality-of-life impact of this plan could be truly transformation for Kershaw County. I am very committed to helping the plan move forward on a timely basis.”

(The online version of this story has been modified to correctly state the standard time response radius distance between EMS stations. The original copy, and as printed in the Chronicle-Independent, incorrectly referred to a 12-mile radius instead of a 12-minute radius. A correction will run in Friday's printed edition of the C-I.)

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