Dixie Regional was recently named one of the Thomson Reuters Top 100 U.S. hospitals. What are some factors that contribute to excellence?
Some of it has to do with the fact that we’re part of Intermountain Healthcare. Intermountain has developed a culture that strives on best practices. We want to do high quality work in the most efficient way possible. We want to provide the best care at the lowest appropriate cost. We measure our CMS scores monthly. We look for best practices at low costs, to drive out variations. And we have a real dedicated group of administrators who sincerely care about each other.
What are some of the things your finance team does that has helped lead to Dixie Regional's success?
In the last two or three years we felt we had grown a bit complacent, so we made some changes on the finance end. We realized that finance had to be a partner with operations. As a result, we aligned our finance staff with our operations officers and developed tools for our directors, managers and operations officers to work on finance and clinical goals together. We pair finance staff with operations officers to review budget issues. We place a great deal of emphasis on capital budgeting so it links with strategies. We review our financials and measure our staffing levels daily.
And I can’t say enough about our physicians. We created a physician clinical council. The physician leaders from all our clinical areas meet once a month to go over finances in those areas. We also have physicians serving on our central corporate teams. That really helps with usage and better pricing. We have a business steering committee that includes a reimbursement specialist and managers from our PAS business office. We address important issues, such as medical necessity in the ED, or the accuracy of our order sets. We standardized a lot of our supplies and equipment and have implemented infrastructure changes for power and water. There is such a tight link between finance and clinical now. When we first linked finance and clinical directors, our finance team visited these clinical areas. We want our finance team to understand how equipment is used by clinicians, how the departments are operating. Getting our finance people more clinically oriented has been really beneficial.
Can you describe some of the financial challenges that are unique to your region and your patient population?
We’re in the southwest corner of Utah. Before the economic slowdown, we were considered among the best places to retire in the U.S. For that reason, we have an older population, who are in need of more healthcare services. We have a higher Medicare mix, and during the last few years our Medicaid has started to climb. For us to succeed, we have to be making money on Medicare patients. That’s difficult because Utah is on the low end of the reimbursement structure through CMS.
There are about 100,000 people in our county. Since we are part of Intermountain, we have been able to develop programs that wouldn’t normally be offered in areas of this size. We are the sole community hospital in our area, but we don’t want to remain complacent. We have a great CEO and a culture that emphasizes doing the best.
What's been the biggest financial impact of the recession on Dixie Regional?
Over the past two years, economic growth has slowed. The housing industry was hit hard in our region. Medicaid volumes climbed. Utah is struggling with Medicaid payments and reimbursement, as are our neighboring states. Our volumes have been soft, and margins are hard to come by. We have seen a decrease in our volumes in ER and elective surgeries.
What kind of capital investment projects do you have planned for 2010-11?
For the next year or two, we’re not planning on any major program development. We just finished a major project – our health and performance center. It’s geared to wellness. We have community outreach, outpatient surgery areas, and a comprehensive spine program. We’ll be getting a LifeFlight helicopter here in the next year. We’re moving toward being a tertiary referral center for some of our rural areas.
What suggestions and/or best practices would you offer to other hospital CFOs to help improve overall quality and financial performance?
One of the things I’ve learned in the last five years is that CFOs need to get out of their offices. To be successful, CFOs need to spend more time with the operations team, one-on-one and in meetings. We need to understand the challenges that are being faced by operations. Conversely, the operations teams need to understand our finance issues. It’s key that you have good working relationships. Downstream benefits will flow from those relationships. You can work with your finance team to involve them in best practices, helping them learn what tools are necessary for management. It’s also important to have a very strong management engineer, who is looking at your workflows and understanding how to become more efficient. The link between finance and operations is the key to this.