Holy Cross Hospital Success Story
Always reaching…This hospital’s tireless medical and clinical staffs, with leadership from QHR, serve both local and indigent populations and wealthy retirees with an unwavering commitment to excellence.
Far Beyond the Basics
Though pressured by fast rising uncompensated volumes and a weak payor mix, Holy Cross Hospital and its medical staff do more than care for the sick. They’re reaching out to improve the health of their community.
“Three years ago, a QHR reimbursement analyst found us a Medicare Demonstration Project opportunity,”remembers CEO Kean Spellman.“It’smaking a huge difference for both the community and the hospital.”
Diabetes is a serious problem for the region: about 16% of Holy Cross admissions have that diagnosis.CMS recognizes the nationwide trend: Medicare spends 20% of its budget on diabetes care.The project allows the hospital an increase in reimbursement (to a cost-basis for all inpatient care) to develop a model to manage diabetes.
“We screen every inpatient,”Spellman reports, “to identify diabetes in the early stages.”A dedicated case manager coordinates care for diabetic patients,coaching them and their families on diet and exercise.“The goal is to show Medicare that with prevention,we can keep people healthier… and out of the hospital.”
Improving the health of the community and quality of care are top priorities at Holy Cross.
“QHR’s quality consultants have helped us refine our processes and develop a culture of improvement,”Spellman says.“It’s working: we’re one of the leading hospitals in our system.”
Investing in Service
A growing reputation for quality raised market share from 45% to 80%.“We had the Bethlehem syndrome: no room.”
Known as a resort destination and a popular retirement community, Taos is also home to a large share of America’s poorest.“Our ER continues to set records – for uncompensated, non-emergent care,”he adds. Over the past eight years:
- Admissions grew by 46%
- Outpatient and inpatient surgeries rose 40% and 21%
- ER and outpatient visits are up 16% and 11%
To meet demand,the board dug into reserves and borrowed to double capacity with a $14 million construction project,including a state of the art OR and a physical therapy joint venture with physicians.
“The expansion was desperately needed… and it was our financial stability that allowed us to accomplish it,”comments Board Chair Ron Burnham. “There’s no question that our motivated, high quality QHR management team is responsible for that success.”
Staying Sharp
CFO Ric Eisenring points out, “there’s no room for inefficiency at Holy Cross.”Net revenues have risen 165% in the last eight years,but expenses are up 167%.
“New Mexico’s indigent care subsidy helps cover the cost of care for some uninsured patients who don’t qualify for Medicaid,but it’s never enough. And expenses continue to rise.Salaries were up $1 million in the last year alone.”
A tight revenue cycle helps.
“We take full advantage of QHR’s consulting expertise,” Eisenring explains.His team has most recently benefited from a Health Information Management assessment, which found a need for cross training coders and a chargemaster review to keep managers up to date.
Leveraging QHR support,the team has kept Holy Cross healthy over eight years of growth and development:
- Total assets climbed from $12 million to $42 million
- Days cash remain strong at 100,down from 180 before the expansion
- Net A/R days are in the low 40s
Business—Not As Usual
Holy Cross is determined to increase access to care for Taos. “We’re isolated here,”describes Burnham.“We feel it’s important to provide what the community needs.” The organization reaches out with First Born,a program that educates first-time parents on infant care,by underwriting a clinic in rural Penasco, which is even more isolated in the mountains,and by working with other organizations through CATCH (Collaborative
Action for Taos Community Health).
But the most critical investment in quality and access is made by and in the medical staff.
“We are fortunate to have a medical staff that is engaged,” Ron Burnham insists. “They’re dedicated to Taos, and subsidize a lot of care themselves.”
But recruiting new physicians to the area has been difficult. “The reimbursement climate is tough. So in the last few years,we’ve had to resort to employing them, especially in certain specialties.”
This is a money-losing enterprise for the hospital, but ensures much needed care in areas like OB, surgery and pediatrics.
“Holy Cross is a big version of Robin Hood, Spellman smiles.“We deliver $1 million a month in charity care.” He’s especially proud that despite its challenges, the hospital is able to support medical staff growth.
“This may be our greatest contribution to the community. We’re now directly subsidizing physicians…to meet our mission.Without the hospital, Taos wouldn’t have this care.”
It was a new problem. Spellman relied on QHR.“We went to sessions on physician employment and practice management,and consulted with other QHR hospitals to learn how to make our contracts fair,with incentives for productivity and quality.”
What’s Next?
“Our challenges are ongoing,” Burnham asserts. “Hiring physicians – while our reimbursements are ratcheted down – is a risk. But it’s one we have to take for Taos. With QHR’s support,we believe we can make it work. QHR’s consulting is exceptional,especially in finance and management.Our results are a testament to that.”
Dr.Foster, a hospital physician and trustee, is pleased to see new physicians arriving.But his primary goal is raising quality. He isn’t alone.
ER and OR departments have implemented Lifewings, a patient safety model adapted from the aviation industry. It will soon roll out to the rest of the facility.
And recent IT initiatives at Holy Cross have a quality focus. New wireless communication will keep patients and nurses connected and track call response times.
“Holy Cross does a great job for a small hospital,” believes Dr. Foster. “But we agree that’s not good enough. We want to keep getting better.”
"I appreciate the stability of our relationship with QHR. Before that, we'd been focused on surviving day to day. Now, we can focus on where we want to be in five to ten years...and how we're going to get there."
