Cape Cod Healthcare

Source: Healthcare Digital

Date :29/06/2007 15:41:34

With control of both local hospitals, Cape Cod Healthcare is looking to grow in the are of outpatient services, as it keeps local residents in top health

Written and produced by David Weldon & Thomas Venturo

Visitors to Cape Cod, Massachusetts, generally leave the area with a favorable view of its scenery, its recreation, its hospitality, and its quality of life.

It’s not surprising. The 15 towns that make up “The Cape” have a distinct neighborly charm and a less-hectic pace that makes them seem a bit more timeless than their neighbors just over the Cape Cod Canal.

Other than Long Island, Cape Cod features the largest separated land mass — and population — stretching out into the Atlantic. This distinction encourages local residents to think of themselves as a broader community unto themselves, something they have done as far back as the original landing of the Pilgrims at Provincetown (that’s correct, not Plimoth Rock).

Whether they are from the entrance community of Sandwich, the mid-Cape town of Dennis or — at the extreme outlining point — renowned Provincetown, Cape Coders share a sense of mutual dependence on each other, and separation from the state proper.

This sense of self-reliance also carries to the region’s healthcare network. Most residents rely on local physicians, medical centers and hospitals for their basic care. Cape residents don’t need to cross the canal for much, and tend to venture the hour long drive North to Boston only for highly specialized services.

And that scenario is just fine with administrators at Cape Cod Healthcare, in Hyannis, who are in the enviable position of owning both of the two hospitals that serve the entire Cape.

“The overall market for inpatient services in Barnstable County is approximately 26,000 hospital inpatients per year, and we have 75 percent of that market,” explains Gregory W. Hunt, vice president of marketing and community relations for the hospitals.

Controlling both of your region’s hospitals would seem to be just what the doctor ordered when it comes to maintaining a healthy bottom line. And in healthier times, it would be. But the healthcare industry is one undergoing dramatic changes in how treatments are provided, patients are managed, and services are paid for.

These changes are affecting individual hospitals differently, depending on how financially strong they were to begin with. Some hospitals are weathering the changes well, many are struggling, while still others are close to the point of life-support.

Cape Cod Healthcare is among the care givers that are doing fine, thank you. In fact, in the area of philanthropy, it is far ahead of most hospitals.

“A real differentiator here is our success with philanthropical donations,” according to Hunt. “A healthcare system this size could expect to get approximately $5 million per year in donations. We are fortunate that the community supports our system with about $14 to $15 million.”

The reasons for the public generosity: “the reputation of our excellent care, and some of our patients have the means to support us with large donations,” Hunt explains.

Still, Cape Cod Healthcare needs to grow, and its own geography is starting to work against it.

“In terms of in-patient care, we’re in a good position. It is ours to lose,” explains Hunt. “The outpatient market is where the growth is.”

And Cape Cod Healthcare has much to gain in the area of outpatient services — the care that is provided by individual doctors, small medical groups, and specialists that work out of their own office space. That is an area where the hospital has not historically put strong focus, until now.

“We’re looking to recruit doctors that can compete in this area,” Hunt says. And just as Cape Coders don’t venture over the canal often for health services, neither do residents on the other side come to the Cape for those same services.

What that essentially means is that Cape Cod Healthcare is trying to lure more individual Cape physicians into its overall network of healthcare services, while letting the physician stay at their remote site. If Cape Cod Healthcare can convince the physician to come on board, the hospital brings the remote office into its care management, records access, and billings systems, and provides the logistical support needed to access, integrate and manage those systems.

This is placing a new burden on the information technology services at Cape Cod, which are also neck-deep in other critical projects involving large-scale revamping of electronic patient records management systems, prescription management systems, and patient billings systems.

In fact, just about every aspect of a patient’s stay at Cape Cod Healthcare is undergoing a technical make-over.

“Much of what we have to do now, especially with Medicare and Medicaid patients, is based on detailed coding, especially if a complex patient is brought into our system through the emergency room” explains Rick Mason, interim chief information officer at Cape Cod Healthcare.

Partially due to recent federal mandates, and partially in response to tougher reimbursement requirements from insurance companies, Cape Cod Healthcare finds itself under the microscope in terms of how it handles, and documents, every step and every procedure of a patient’s stay while under its care, from admission to discharge.

The hospital isn’t alone in that scrutiny — virtually every health care provider is in the same boat.

From the moment a patient is admitted, every touch point, as it were, must be documented in detail, put into digital file format, and be made accessible to anyone that might need that information. This patient records database then becomes a primary tool in all subsequent services for the patient, and collecting payment for them.

To stand up under that scrutiny, the hospital must get its IT infrastructure in peak form. And three major factors are now driving Cape Cod Healthcare in terms of how it invests in technology, and how it revises its processes, according to Mason.

First, insurance companies are placing more requirements on providers to document the services they provide each patient, in order to pay out on those services.

Second, the amount that insurance companies will reimburse for individual services is dropping, placing greater pressure on providers to trim their own costs, while insuring that no services are withheld from the patient, or from billing.

Third, a variety of federal and state mandates are requiring providers to implement new technology-driven systems for accessing patient data, and managing it electronically and reporting on the quality of care provided.

The good news in all of the above, should be improved care for patients on a national basis. After all, in order to trim costs but still maintain high standards of quality care, hospitals need to get more efficient. By better documenting the services they provide to each patient, the hospital will have more and more detailed information on each patient to use in diagnosis. And by improving the accessibility of patient data, physicians, nurses and other care givers that need to access data will be able to do so wherever, and whenever, they need.

One of the largest investments has been in implementing a Picture Archiving and Communication (PAC) system, which stores medical images such as x-rays, CT-scans, ultrasound, or other scanned images.

“This system has increased the digital quality tremendously, and also improved the turnaround time from when a patient arrives at a department, to when a physician has access to the images,” according to Joseph Walsh, senior manager of information systems.

While there has been much public discussion about the desire for a total electronic patient record, Mason says that is still a ways off. Still, the PAC system “is one of the steps toward that. It is a significant step, and the one most heralded by physicians.”

First steps can be the hardest, however, and that was the case for Cape Cod Health with the PAC system.

“We had to change to whole process of how records are stored,” Mason says.

Another major technology project is a new patient electronic medication administration records system (eMAR).

According to Peter L. Lavigne, manager of clinical information systems, this new system has been in place for approximately one year at Falmouth Hospital (in Falmouth, Mass.), and will shortly be implemented at Cape Cod Hospital in Hyannis.

Again, another step in the journey to a total electronic patient record, this system enables all health care providers that have dealings with a patient to have access to the same medication records on that patient, which are started at the moment of admission. The intent is to ensure that all concerned know the proper medications, proper doses, and proper scheduling for the patient, to eliminate errors or omissions.

A second phase to this project, Lavigne says, would be to incorporate a bar coding application into the system as well, so that all medications prescribed to a patient could be bar-coded when prescribed, and then electronically swiped against the patient’s electronic file later, before any medication is administered.

Lavigne says that Cape Cod Healthcare is also working with MediTech Corporation as the beta site for a new oncology project, which would develop a life-long medical record system for cancer patients.

The first phase of this project, underway now, involves the coding of the initial software program and modifying it to the hospital’s records management processes. The second phase will tie it to physician treatment plans and medication dose records. This project has been underway for three years just in the initial phase, Lavigne says.

A national technology initiative that Cape Cod was part of and which just “went live” is the National Provider Identification system, which is an electronic system for assigning digital identifications to all care providers. This is another step toward the national total electronic patient record goal.

“The most significant impact on us currently, is that we are now required to have the NPI numbers on all claim forms in order to be reimbursed for services,” Mason says. It can be a laborious process to track down identification numbers for care providers that aren’t part of the hospital’s actual staff, in order to have those records properly processed. Just becoming compliant with the new NPI system took a year, he says.

As much work as it is to upgrade the hospital’s systems to integrate these new services, there is an early payoff, Mason says.

“Part of what we’re doing is enticement,” according to Mason: being able to bring new primary care providers into the network. “If they are brought in, we would run their office, and be able to support and maintain these new technologies for them.”

Most importantly, though, is the simple benefit to the patient.

“We are driving better quality outcomes through the use of IT,” Walsh says. “I see these projects as a way to insure that the physicians working with Cape Cod have access to excellent records, that they can interface with us, that they can order items and services for the patient and have access to the records on them, and that they can also network with each other.”

Managing all of these services is a daunting task, and the hospital does outsource some services, including a portion of the physician billing and Macintosh support.

In terms of hospital staff, there are approx-imately 4,600 employees overall, with approx-imately 3,700 FTEs, or full time equivalents.

At full strength, the IT staff would have 50 full time employees, including three full time RNs within the IT group.

The presence of nurses within IT might seem unique, but in fact, the IT department is heavily populated by staff with a medical background of some fashion. Lavigne has a pharmaceutical background.

It also makes sense in terms of the general calling in the healthcare field in the first place.

As Hunt notes, no matter what department they work in, those in a hospital or health care setting are drawn to it by the desire to help others and make a difference in their lives.

It is what led Hunt, Mason, Lavigne and Walsh to all find their way to Cape Cod Healthcare, and it is the best recruiting tool a company could have, Hunt notes.