CAMBRIDGE -- As the world of health care continues to change, the challenges community hospitals face have become increasingly difficult to navigate. The Board of Directors, administration and physicians at Southeastern Med are aware of the many changes and remain proactive in addressing the many challenges.

In 2012, residents of Guernsey County connected with Southeastern Med during their most cherished or grief-stricken circumstances. Southeastern Med treated more than 30,000 in its Emergency Department, admitted over 4,000 patients and birthed 435 babies.

The hospital also made a substantial imprint on the local economy and financial drivers in the county as the area's largest employer. Blessed with a history of strength, physician and community support, Southeastern Med is in the midst of managing the many changes that are accompanying the Affordable Care Act.

The shift of risk from payer to provider, decreasing insurance reimbursements, staying up to date with the latest in medical technology, maintaining the hospital itself and physician recruitment are just a few of the factors Southeastern Med deals with on a daily basis. The Board and Senior Management at Southeastern Med are taking an internal review of its current business model with the goal to improve quality, reduce cost and enhance the customer experience.

Ray Chorey, president and CEO of Southeastern Med, addresses the challenges the hospital is facing and the immediate actions the hospital has taken to succeed in the current and future healthcare environment.


The Patient Protection and Affordable Care Act

Under the Patient Protection and Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) began using value-based purchasing to improve quality and lower costs. Under the Hospital Value-Based Purchasing Program, the government now pays hospitals according to how well they perform on a set of standard clinical quality measures and on patients' responses to the surveys hospitals mail them after their use of an inpatient or outpatient service.

CMS began monitoring the hospital's performance in July 2011 to generate its performance score. In 2013, if the hospital falls below that performance score, its Medicare reimbursement for the care we provide will decrease. If the score remains the same or improves, its reimbursement will increase.

"CMS will simply take money away from the hospitals with low scores and reward it to those with higher scores," Chorey said. "Providing outstanding patient care has always been our primary mission, and value-based purchasing will be a testament of our ongoing efforts to improve the quality of care we offer to "always" meet the expectations of our patients."

In 2013, CMS can withhold up to 1.5 percent of a hospital's reimbursement based on their value based performance scores. If Southeastern Med falls below its performance score, it estimates a $375,000 decrease in reimbursement for the Medicare services it provides.

While Southeastern Med meets and often exceeds many of the national benchmarks for care, it will continue to focus on improving its current outcomes by addressing efficiency in the care provided with special emphasis on customer satisfaction. The hospital is currently in the process of establishing a well-integrated program that aligns customer service with business goals. In November, Southeastern Med appointed Rory Cox as its customer service coordinator to lead the project responsible for the customer experience.

"Rory offers an attitude and skill set that will be a benefit to our Customer Service Program and be an asset to our patients," Chorey said. "Her commitment to customer service aligns with our priorities, and her efforts to build a well rounded program will benefit everyone working at Southeastern Med."

Another focus for Medicare reimbursement is 30-day readmissions, which refers to patients who are readmitted to the hospital within 30 days of being discharged. As of October 2012, in addition to no longer paying for the care provided for any readmissions, CMS began lowering payment rates for Medicare discharges on hospitals with higher-than-average readmission rates for certain conditions, including heart attack, heart failure and pneumonia.

In an effort to minimize readmissions, Southeastern Med is focusing on always meeting each patient's need to understand their care plans, discharge instructions, tests and results, as well as the importance to communicate with their nurses and physicians. Southeastern Med recently received a grant in collaboration with the Area Agency on Aging Region 9 to utilize Life Coaches to assist with the transition from hospital to home for those patients with a high probability of being readmitted within 30 days of discharge.

"There is a lot of activity within the hospital to better our discharge processes," Chorey said. "We have redesigned it to make sure patients receive the proper education about their illness and treatment plan before discharge. We are also reaching outside the hospital with rehabilitation centers, nursing homes and specialty physicians who follow patients after they're released from the hospital to make sure they are getting the ongoing treatment they need. We are really excited about the opportunity to collaborate with the Area Agency on Aging to help our patients remain home one we have made them well."

In 2012, Southeastern Med also completed a Community Health Needs Assessment required by the Patient Protection and Affordable Care Act. The purpose of the survey was to identify the health needs of the Guernsey County community. Hospital leadership will use the survey results to work collaboratively with other healthcare providers to meet the current and future needs of the community. Survey results will be shared with the community after the Board of Directors approval in mid 2013.

The aging facility and access to capital

The average age of many healthcare facilities is increasing, and Southeastern Med is no exception. The West Wing of the hospital opened in 1952 as an 84-bed hospital known as Guernsey Memorial Hospital. The hospital underwent a major $10 million expansion to add the South Tower in 1974. Since then, Southeastern Med added a new 13 bed Intensive Care Unit and renovated its Emergency Department.

In 2012, the hospital spent more than $1.8 million for upkeep and preventive maintenance on the hospital building and structures, as well as medical equipment. The hospital's Maintenance Department is responsible for the operation and maintenance of all mechanical, electrical, and plumbing infrastructures throughout the organization and its properties.

"Facilities management has become very challenging and those challenges will continue to grow moving forward," said Jeff Hayes, Senior Director of Facilities at Southeastern Med. "We continuously strive to meet the needs of community through providing additional services, equipment and space. We want to provide the highest quality care in state-of-the-art facilities and doing so in an environment of declining reimbursements, increasing regulatory requirements and aging infrastructures will be hurdles all community hospitals will face moving forward."

In 2012, Southeastern Med purchased the Cambridge Regional Cancer Center and launched a new hospital information system. The Southeastern Med Auxiliary also improved patient care with the purchase a Cepheid GeneXpert System.

Southeastern Med expanded its successful cancer service line by purchasing the Cambridge Regional Cancer Center from the American Oncology Associates, Inc. The Cambridge Regional Cancer Center offers advanced hematology and medical oncology services for patients with many different types of cancer, including breast, lung, colon and genitourinary cancers, as well as benign and malignant blood disorders, such as anemia, lymphoma, leukemia and myeloma. In early 2013, the cancer center will begin providing radiation oncology services. The hospital used $450,000 donated to the Guernsey Health Foundation to help purchase the facility.

"Southeastern Med would not be the healthcare asset it is without the longtime support of our donors," Chorey said. "And we are thankful for the generous friends who make a profound impact on the achievements of the hospital through continued financial support of the Guernsey Health Foundation."

As the hospital began its journey into the new era of healthcare reform in 2012, Southeastern Med made significant investments in a new hospital information system, Meditech, to electronically streamline patient medical records.

With the federal government's passing of the Health Information Technology for Economic and Clinical Health Act, part of the American Recovery and Reinvestment Act, hospitals must now demonstrate they are meaningful users of Electronic Health Records (EHRs). The U.S. Department of Health and Human Services (HHS) outlined these criteria for meaningful use:

Improve quality, safety, efficiency and reduce health disparities;

Engage patients and families;

Improve care coordination;

Improve population and public health; and

Ensure adequate privacy and security protections for personal health information.

"Technology plays a pivotal role in today's healthcare environment, and I am extremely proud of our organization's commitment to using technology to meet the highest standards in healthcare," Chorey said. "Our number one priority is to provide our patients the safest, affordable, high-quality care possible. By investing in and launching, Meditech, we are now at the forefront of using electronic medical records to better meet the needs of those we serve."

The use of Meditech allows caregivers to obtain and update a patient's medical record and medications and immediately access laboratory and X-ray reports, and other test results at the patient's bedside. In many cases, this information alters diagnosis and treatment decisions, as well as decreases the potential duplication of costly

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services. Meditech also promotes medication safety by notifying the physician if a drug being prescribed will have an adverse effect based on the patient's other medications. Meditech will also enable Superior Med physicians to schedule ordered tests to be completed at the medical center from their office.

Ultimately, the new system allows physicians to keep better track of their patients' health, no matter where they may be. "Before electronic medical records, if a physician was concerned about a patient, they had to call and have a nurse read the chart," Chorey said. "Now, they will have access to patient information anywhere they have internet access - from their offices to their homes."

In 2012, the Southeastern Med Auxiliary purchased in a Cepheid GeneXpert System for the hospital to reduce turn-around-times for vital lab tests from days to hours, enabling doctors to make quicker, more informed treatment decisions.

The Southeastern Med Auxiliary is dedicated to enhancing patient care through community fundraisers. Each year, Southeastern Med's Auxiliary works with the medical staff to decide upon a major piece of medical equipment needed by the medical center. This year the Auxiliary pledged $84,000 toward the cost of the Cepheid GeneXpert System. In recent years, the Auxiliary has also purchased SMART intravenous (IV) pump technology, a STERRAD NX System the Sterile Processing Department and MRI breast array coils. In 2013, the Auxiliary has pledged $75,000 for the hospital to purchase four new beds for the Intensive Care Unit.

This technology not only saves lives, it helps reduce overall healthcare costs.

"Before the GeneXpert, testing involved a typical turnaround time of 24 to 48 hours which forced clinical care to proceed under the assumption the patient was infectious," said Debra Banna, director of Laboratory Services at Southeastern Med. "This machine reduces healthcare costs by eliminating the step of prescribing antibiotics that might not work or isolating a patient when it isn't necessary, which is extremely costly."

Physician Recruitment

In today's healthcare market, it's becoming more challenging than ever for rural communities, like Cambridge, to both recruit and retain physicians due to numerous factors, including location, economics and health care resources, such as hospital bed capacity, practice scope of service and lack of specialists. These and many other factors place rural communities at a recruitment disadvantage to its larger neighbors.

"The physician shortage is real," Chorey said. "It's difficult to not only find a primary care physician or general surgeon but it's equally as difficult to find one that is willing to move their family to a small rural community. That's always going to be a problem. We are committed to partner with excellent physicians whose personal and professional needs are met in the community we serve."

It is this commitment on the part of the hospital and physician leadership that has enabled Southeastern Med to retain and recruit new physicians. In 2012, two new physicians joined Southeastern Med's medical staff and another is set to join the hospital in August 2013.

During the summer of 2012, Nabiel AlKhouri, M.D., joined the hospital as its new medical oncologist/hematologist at the Cambridge Regional Cancer Center and Ramakrishna Kasindula, M.B.B.S, M.D., Pediatrician, joined Southeastern Ohio Pediatrics with pediatrician Muhammad Noor, M.D. In August 2013, Michael Myers, D.O., orthopedic surgeon, will join Southeastern Ohio Orthopedics with established orthopedic surgeon Corey A. Jackson, D.O.

As Southeastern Med prepares for new challenges in 2013, its dedicated Board of Directors, senior administration, physicians and staff are equally committed to making an important contribution to the health of the community as a whole. In 2013, the hospital will not only be seen as a place for the sick, but also as a center of wellness in the community.