November 9th, 2011  Posted at   Healthcare Systems
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Insights and Strategies for Recruiting Executives in Small and Rural Hospitals

Marie Vienneau chuckles as she describes the setting of Maine’s Millinocket Regional Hospital, the 25-bed Critical Access facility over which she presides as CEO: “We’re a small town in a cold climate, 40 miles from the nearest Walmart. The North Maine Woods begins just north of us… we’re literally at the end of the road.”

For Vienneau, and thousands of other small and rural hospital CEOs, directors and board members like her across the country, isolation determines the way in which both hospital staff recruitment and retention are accomplished. And yet with 20% of the US population living in areas defined as rural by the 2000 US Census (now totaling over 60 million Americans), the need for effective staffing in out-of-the-way locations is as great as ever.

When it comes to recruitment in small and rural hospitals, and despite popular perceptions, the good news is that it’s not all bad news (not by a long shot). Many of the most successful small and rural hospitals, in fact, use their unique surroundings and remote locations to their advantage in bringing aboard qualified medical staff at all levels. One key, it seems, is in knowing how to leverage a small or rural hospital’s unique assets.

Play to your strengths, but don’t oversell

Stressing the benefits of life in a beautiful, natural setting, far from the congestion, crime and high cost of living more typical of urban areas, was a recommendation made by nearly all of the people interviewed for this article. Tana Casper, for example, Chief Nursing Officer of Grand Itasca Clinic & Hospital in Grand Rapids, Minnesota remarked, “Because of our location and the characteristics of the region, our appeal is the outdoors and an outdoor lifestyle. It’s an important part of any recruitment,” she says, “and we include a heavy emphasis on the region and what it has to offer in our recruiting materials, our Web site, and our discussions with potential hires.”

For those who appreciate rural life, the opportunity to enjoy fishing, camping, hiking and other outdoor activities year round, and just minutes from where they live and work, is a treat and a benefit to relocation. That said, successful candidate placement comes not from convincing people to relocate to small and rural areas, but rather from finding people who will be a good fit because of the interests they already have.

As Joseph Woodin, President and CEO of Gifford Medical Center in Randolph, Vermont, explains, “If somebody doesn’t want to be here, you can’t pay them enough to be here. An extra $50,000 to be in a place you don’t want to live doesn’t work.”

Instead, says Woodin, the key is to have frank conversations with candidates about what life is like, and to not overstate the benefits of small town living. Woodin’s discussions with candidates include providing information regarding distances to nearby cities, quality of schools, recreational activities, and of course, weather – all in an effort to put all the cards on the table. Woodin has these discussions early in the interview process and continues probing to find out why a candidate might want to live in rural Vermont. Drilling down with candidates regarding their interest in the region allows him to differentiate between the person who will fit in well and thrive in a rural setting, and the person who is simply attracted to a fictional fantasy of small-town America. Read more… »

November 9th, 2011  Posted at   Healthcare Systems
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This article is intended to encourage the conversion of chart data from your legacy EMR into a new EMR. It is the author’s hope that discussing potential problems and their magnitude will encourage careful planning and the assignment of adequate resources to complete the project successfully.

The complexities, increased risks and potential problems associated with the migration of chart data from one EMR to another create more than anxiety. They are the source of potentially serious problems. However you can migrate your data successfully and avoid all associated problems or manage them within your established risk tolerance.

The four keys to succeeding are:
1. planning
2. allocating the best people resources within your organization
3. selecting a qualified conversion partner
4. hiring an independent consultant

Independent Consultant:
A consultant can be likened to a keystone which is placed at the apex of a stone arch. Without the keystone, the strength and stability of the arch is severely compromised. Much effort will be expended to shore up the arch in the absence of the keystone.

The role of an independent consultant is to bring the three or four parties together on a level field of communication. The reason real estate brokers don’t like buyers talking with sellers is the all too frequent breakdown in communications which nearly always results in a dead deal. The same applies here. The consultant can hear and say things the various parties cannot and that communication is vastly important in the complex, hugely time consuming EMR Implementation project. The consultant must address the data migration directly. He or she may or may not be assigned responsibilities for the full implementation project.

Suggested tasks for the Consultant:
1. clarify and document expectations of each party
2. review the data migration plan
3. modify the plan as needed
4. understand and communicate what can and what cannot be migrated and why
5. identify and communicate data items which may not be available for conversion and why
6. these data items will remain questionable until the conversion work is underway
7. determine and document the testing criteria required to validate an acceptable conversion
8. document why some items can be accepted with less than 100% accuracy and get all parties to agree in writing
9. monitor the time table at major deliverable points
10. monitor and report progress between major deliverables
11. ensure complete and open communication among all parties Read more… »

November 8th, 2011  Posted at   Healthcare Systems
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Many people do not know their patient rights if they feel that they are being discharged from the hospital too soon. If you think that it is medically necessary for you to stay in the hospital a little longer or if the transition to post-hospital services is not acceptable to you, you can appeal the decision for your discharge.

Medicare beneficiaries are able to utilize this appeal process since Medicare wants to ensure that each patient is receiving timely, quality health care. Medicare hires a Quality Improvement Organization (QIO) in each state to address health care quality concerns for their beneficiaries. The Center for Medicare and Medicaid requires hospitals to notify patients of their rights to appeal a decision for discharge. This written notification, which is called Important Message from Medicare, must be given to all patients to review and sign within the first 2 days of hospital admission. If you are in the hospital for more than 3 days, you will receive the notice again no less than 4 hours prior to your official discharge.

The timing that you file your request for appeal is crucial for the discharge process and has financial implications that affect you. If you have received official notice of your discharge date and you think it is premature, you must request your expedited review by noon of the next day. You must make your appeal no later than midnight on the date you are to be discharged while you are still in the hospital.

How do you appeal? The process to start the appeal is easy. All the information is provided in the Important Message from Medicare notice that you reviewed and signed, or someone with your permission did on your behalf. The contact information for the QIO in your state is listed on the notice as well as instructions on how to file your complaint. The QIO that serves Colorado is the Colorado Foundation of Medical Care. Their direct phone number for the Medicare Beneficiaries Hotline for Complaints and for Expedited Review Requests is 800-727-7086.

How does this affect you financially? You can stay in the hospital while Medicare pays for your care until your appeal decision has been determined. Medicare beneficiaries are not financially liable for hospital costs while their case is being reviewed by the QIO (except co-pays and deductibles). If the QIO agrees with you that it is too soon for you to be discharged, then you can stay in the hospital and Medicare will cover your costs. If the QIO agrees with the hospital’s decision for your discharge, then you will be required to pay all hospital bills beginning at noon on the day AFTER notification of the decision was made. Patients do have the right to request an expedited reconsideration if they do not agree with the QIO’s decision. Initiating the appeal process buys you some time and can save you money while the QIO reviews your case. Typically, a decision will be made within a few days. If you decide to not appeal the hospital’s decision for your discharge and you continue to stay in the hospital, you will be required to pay all hospital bills after the official discharge date. Read more… »

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