Floyd-Clark differences
People keep asking why Floyd Memorial is successful when Clark County is struggling. I have mentioned before that Clark County has been in the red for the third consecutive year and in 2005, by about 7 million dollars from what we have heard.
So what are the differences?
1. Clark County is managed by Jewish hospital. Jewish charges a tremendous management fee for the services and then basically funnels patients out of Clark and over to Jewish for the lucrative procedures. Jewish has done this with many outlying smaller hospitals. Physicians refer to these as the satellites feeding the “mother ship”. Unfortunately, when these smaller hospitals become more of a detriment, Jewish will just abandon them. Revenue is not always put back into the hospital.
2. The most important reason for the difference in success between Floyd and Clark County hospitals is the Medical Staff and who the staff is affiliated with or where their loyalty lies. The largest primary care group in Clark County is the Dr. Spalding Group. It has many primary care doctors all in one group. The practice is now owned by Norton Healthcare. The office in Jeffersonville is basically a completely self-contained operation. They provide all of the outpatient tests and procedures that would normally go to the hospital. They have their own x-ray facility, their own lab, ultrasound, CT scan, MRI. They do minor surgical procedures in the office and when patients need admitted, they are directed to a Norton facility. They have basically eliminated the need for the hospital and they have a very large patient base in Clark County.
In addition, there are at least 2 outpatient CT and MRI freestanding facilities privately owned taking the lucrative procedures away from Clark.
There were 5 OB/GYN doctors that quit doing OB at Clark in January of 2005.
The lucrative outpatient procedures are continually lost because Clark County physicians are doing more and more in their offices or in other facilities they own. This leaves Clark with more money-losing inpatients on a percentage basis.
Clark may soon lose a lot of their orthopedic procedures because the physicians are looking at building their own spine/orthopedic facility to perform these procedures.
3. The Clark County government has been much more open to businesses over the years and has allowed numerous facilities to flourish and create competition. Floyd County has not been as open and inviting to businesses and can be readily seen by the disparity in growth between the two counties. Their location to Louisville has also contributed to the growth.
4. Nursing staff and other ancillary support personnel has remained very loyal to Floyd even when salaries and benefits fell behind. They used to feel Floyd was like a family and they stuck with it. But turnover rates have worsened in the past few years and more staff are leaving for other opportunities.
5. The Medical Staff at Floyd has historically been a very tight-knit group and very loyal to the hospital. In addition, most of the primary care doctors and many of the specialists actually lived in Floyd County. The percentage at Clark has been much less. But when you look at the facts and trends in how the environment is changing, you can see that we are becoming more like Clark County in the physician makeup. Our Medical Staff is becoming much more disjointed from the Hospital and learning they can provide services more efficiently and cost effectively if we do it on our own or with other physicians. This is the one area that Floyd County Physicians have been slow to adopt. But it is changing. In the past 10-15 years, here are some of the changes that have occurred:
i. Opthalmology and ENT services have transitioned to private facilities or outpatient surgical centers
ii. Gastrointestinal procedures such as Colonoscopies, Sigmoidoscopies, and EGD’s are done outside the hospital in private facilities
iii. Cardiology procedures like treadmills, nuclear studies, ECHO’s are being done in the cardiologists offices
iv. OB ultrasounds, GYN procedures are being done in the physician office
v. Bone density scans are done in the office
vi. Many CT scans and MRI’s are being done outside of the hospital in private facilities
vii. Neurologists are doing more of their procedures in their offices
These are just a few of the many things that Floyd has lost over the years. Each one of these physicians tried to work with Floyd prior to taking business away, but was repeatedly met with resistance. They did not want the hassles of starting these things on their own, but as they look back, they realize it was the right thing to do.
The Hospital did joint venture recently with the radiology group for the outpatient imaging facility off Grantline road but not without significant conflicts. The joint venture with cardiology is not proceeding, and the joint venture with the surgeons for an ambulatory surgical center is having problems as well. The surgeons are actually looking at doing it without the hospital, but negotiations continue. The OB/GYN group is looking at changing to Clark County or Norton’s as their hospital-of-choice for deliveries and many primary care doctors will obtain privileges at the new hospital in the area when it comes.
The trend is not looking good. I am sure you will see comments from our anonymous blogger that the physicians were greedy and just looking at making money by taking the procedures out of the hospital. I would encourage everyone to talk with any of the physicians in specialties mentioned above and ask them how they had repeatedly tried to work with the hospital and make changes before they made these tough decisions.
Most physicians will quietly transition further away from the hospital without much awareness as very few seek or enjoy conflict. They want what is best for their patients and when they cannot get it, most have found it easier to start new rather than attempt to change the old.
The differences in success or failure is not because of administrations. Most physicians and employees have seen at least 2 administrations come and go at every hospital in the area. Some have seen 3 administrations come and go. It is the dedication and loyalty of physicians and employees that lead to success. Physicians bring in the patients and thus the revenue, without which nothing could be done. How administrations nurture these relationships to continue bringing patients and revenue to the hospital is their most important job. Comparing the trends at Floyd to what has happened at Clark is worrisome.
So what are the differences?
1. Clark County is managed by Jewish hospital. Jewish charges a tremendous management fee for the services and then basically funnels patients out of Clark and over to Jewish for the lucrative procedures. Jewish has done this with many outlying smaller hospitals. Physicians refer to these as the satellites feeding the “mother ship”. Unfortunately, when these smaller hospitals become more of a detriment, Jewish will just abandon them. Revenue is not always put back into the hospital.
2. The most important reason for the difference in success between Floyd and Clark County hospitals is the Medical Staff and who the staff is affiliated with or where their loyalty lies. The largest primary care group in Clark County is the Dr. Spalding Group. It has many primary care doctors all in one group. The practice is now owned by Norton Healthcare. The office in Jeffersonville is basically a completely self-contained operation. They provide all of the outpatient tests and procedures that would normally go to the hospital. They have their own x-ray facility, their own lab, ultrasound, CT scan, MRI. They do minor surgical procedures in the office and when patients need admitted, they are directed to a Norton facility. They have basically eliminated the need for the hospital and they have a very large patient base in Clark County.
In addition, there are at least 2 outpatient CT and MRI freestanding facilities privately owned taking the lucrative procedures away from Clark.
There were 5 OB/GYN doctors that quit doing OB at Clark in January of 2005.
The lucrative outpatient procedures are continually lost because Clark County physicians are doing more and more in their offices or in other facilities they own. This leaves Clark with more money-losing inpatients on a percentage basis.
Clark may soon lose a lot of their orthopedic procedures because the physicians are looking at building their own spine/orthopedic facility to perform these procedures.
3. The Clark County government has been much more open to businesses over the years and has allowed numerous facilities to flourish and create competition. Floyd County has not been as open and inviting to businesses and can be readily seen by the disparity in growth between the two counties. Their location to Louisville has also contributed to the growth.
4. Nursing staff and other ancillary support personnel has remained very loyal to Floyd even when salaries and benefits fell behind. They used to feel Floyd was like a family and they stuck with it. But turnover rates have worsened in the past few years and more staff are leaving for other opportunities.
5. The Medical Staff at Floyd has historically been a very tight-knit group and very loyal to the hospital. In addition, most of the primary care doctors and many of the specialists actually lived in Floyd County. The percentage at Clark has been much less. But when you look at the facts and trends in how the environment is changing, you can see that we are becoming more like Clark County in the physician makeup. Our Medical Staff is becoming much more disjointed from the Hospital and learning they can provide services more efficiently and cost effectively if we do it on our own or with other physicians. This is the one area that Floyd County Physicians have been slow to adopt. But it is changing. In the past 10-15 years, here are some of the changes that have occurred:
i. Opthalmology and ENT services have transitioned to private facilities or outpatient surgical centers
ii. Gastrointestinal procedures such as Colonoscopies, Sigmoidoscopies, and EGD’s are done outside the hospital in private facilities
iii. Cardiology procedures like treadmills, nuclear studies, ECHO’s are being done in the cardiologists offices
iv. OB ultrasounds, GYN procedures are being done in the physician office
v. Bone density scans are done in the office
vi. Many CT scans and MRI’s are being done outside of the hospital in private facilities
vii. Neurologists are doing more of their procedures in their offices
These are just a few of the many things that Floyd has lost over the years. Each one of these physicians tried to work with Floyd prior to taking business away, but was repeatedly met with resistance. They did not want the hassles of starting these things on their own, but as they look back, they realize it was the right thing to do.
The Hospital did joint venture recently with the radiology group for the outpatient imaging facility off Grantline road but not without significant conflicts. The joint venture with cardiology is not proceeding, and the joint venture with the surgeons for an ambulatory surgical center is having problems as well. The surgeons are actually looking at doing it without the hospital, but negotiations continue. The OB/GYN group is looking at changing to Clark County or Norton’s as their hospital-of-choice for deliveries and many primary care doctors will obtain privileges at the new hospital in the area when it comes.
The trend is not looking good. I am sure you will see comments from our anonymous blogger that the physicians were greedy and just looking at making money by taking the procedures out of the hospital. I would encourage everyone to talk with any of the physicians in specialties mentioned above and ask them how they had repeatedly tried to work with the hospital and make changes before they made these tough decisions.
Most physicians will quietly transition further away from the hospital without much awareness as very few seek or enjoy conflict. They want what is best for their patients and when they cannot get it, most have found it easier to start new rather than attempt to change the old.
The differences in success or failure is not because of administrations. Most physicians and employees have seen at least 2 administrations come and go at every hospital in the area. Some have seen 3 administrations come and go. It is the dedication and loyalty of physicians and employees that lead to success. Physicians bring in the patients and thus the revenue, without which nothing could be done. How administrations nurture these relationships to continue bringing patients and revenue to the hospital is their most important job. Comparing the trends at Floyd to what has happened at Clark is worrisome.
posted by Anonymous at 6:15 AM
4 Comments:
There is money budgeted for this year to upgrade the OB department.
As with many things, it never happens as quickly as some would like.
It is one of the major reasons our OB doctors are looking at making a change.
This is one area that has been neglected probably longer than it should have been.
I have agreed with much of what you have said in the past, but lets be real, many of these md owned facilities create a great deal of income for their practice. One of the local urology groups owns a CT machine and now my need to have continous CT scans has became an every six month thing. Doing EGD's and colonoscopies in your own office is much more profitable than doing one at the hospital as you can tack on a facility charge. The examples are endless, I doubt that the MD's are doing these procedures in their offices for no other reason than increasing their profit(which is OK), but dont lay blame were it is warranted.
Concerned r.n.
Your comments are noted and understood.
My point is that the reason for physicians making these changes over the years was not primarily a money issue.
They certainly have learned that it was a financially good endeavor, but it was not the motivating reason.
You mention urology. I encourage you to ask this physician how he tried working with the hospital. Ask him why Floyd no longer has lithotripsy services. Ask him before they put in their own CT machine what the wait time was for his patients and the turn around time for reports.
Why do you think we now keep monthly statistics on wait times to get scheduled for mammograms, CT scans, MRI's, Ultrasounds, and nuclear studies.
These services were not being met adequately by the hospital.
If you have a patient with blood in their urine and tell them one of the possibilities is a tumor in the kidney and then tell them we cannot get a scan for 2 weeks, it causes problems.
It used to be for lung cancer follow-ups, you would do a chest xray once a year. Then it became a CT scan and now it is a spiral CT scan with thin cuts every 6 months.
Standards of care change. Patient expectations change. Physicians have to meet the needs or be held accountable.
Many physicians are finding out they can do these things better, quicker, more efficiently in their office. As a bonus, yes it does make money. But if the phsycian is responsible for ordering the test, ensuring it is done, interpreting the results, following up on the results and arranging for any subsequent care, why shouldn't he be compensated for that.
The hospital has none of those responsibilities, yet they get more for the exact same procedure than when it is done in a physicians office.
The new addition at Floyd does not seem to have been designed with the nursing staff in mind. The spaciousness is pretty to the eye, but the nurses need roller skates! I've also noted the parking lot is aesthetically designed, but with so much wasted space. Was nursing consulted when designing the patient care areas??
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