• Embed Doc
  • Copy Link
  • Readcast
  • Collections
  • CommentGo Back
Download
 
duke & the community
Beoe economic stom clouds theed, DUHS ws t woseein svins nd enhncements.
It’s hard to miss the stories in the news aboutthe tragic impact the current goba economiccrisis is having on peope and amiies ocayand nationay.North Caroina is being hit particuary hard bythe downturn. The unempoyment rate in ourstate has doubed over the previous year.One o the biggest concerns or peopesuering the trauma o osing a job iscontinued access to heath care services.According to a recent estimate by the N.C.Institute o Medicine, about 1.8 miion NorthCaroina aduts, or about a quarter o aaduts in the state, have no heath insurance.The institute reported ast month that thenumber o uninsured peope in NorthCaroina is growing.In these difcut times, Duke University HeathSystem continues to step up and pay acriticay important roe in providing care tothose in greatest need.In act, in 2008 (the most recent year orwhich compete data are avaiabe), DukeUniversity Heath System provided uncompen-sated heath care services and other directcommunity benefts in Durham, Raeigh andacross North Caroina vaued at $229 miion.“It’s important or a o us, throughout DukeMedicine, to understand that the heathsystem provides a signifcant amount o care tothe underserved, uninsured and underinsured
VOLUME 18 NO. 5
n
inside.duemedicine.o
n
M 2009
M
ore than a year ago, wellbeore “global economicdownturn” became a householdphrase, senior managers withinDuke University Health System sawnancial storm clouds on the horizonand initiated an organization-wideeort to identiy major opportunitiesor cost savings, or where additionalrevenue opportunities might exist.Expectations were signicant— a target o $50 million annuallybetween cost savings and increasedrevenue opportunities. I successul,it was elt the organization would beoptimally congured to move into auture likely to be characterized byreimbursement reductions and prob-able health care reorm proposals bya new administration in Washington.The work that began in March2008 did not benet rom a crystalball, nor did anyone oresee thedepth or breadth o the globaleconomic crisis that took hold inthe last our months o the year. Butthose events signicantly acceleratedthe urgency o this project.The arsighted actions takenover the last year have positionedDuke well to weather the currentuncertainty and prepare or uturegrowth.“While we obviously didn’toresee the global economic collapse,we did see a number o indicatorsearly in 2008 that we elt requiredimmediate organizational attentionto create a nancial structure inwhich we could be successul moving
ee PREPARED, p.2
future
or the
Prepared
Prvidig carewhe i’eeded m
teamwork
tl  d. dz
epl   l    ll   lp p.P 5
inquiry
Bll Bl b
d’  Bll bl   . r b bl' l.P 9
Patient saety
P p
cllb  dcl’  l  f l -l .P 12
ee CARE, p.3
“It's imotnt o us,thouhout Due Medicine,to undestnd tht thehelth sstem ovides sinifcnt mount o ceto the uninsued ndundeinsued ech e.”
— Chncello Dzu
 
on the cover
Iide Dke Medicie
2
May 2009
INSIDE VOLUME 18, ISSUE 5
n
ContACt usCamp mail:
DUMC 104030
Deliverie:
2200 W. Main St.,Suite 910-B, Durham, NC 27705
Phe:
919.660.1318
E-mail:
editorinside@mc.duke.edu
CREDIts
 
Car:
Josh Tayor
stA
 
Edir:
Anton Zuiker
Maagig Edir:
Mark Schreiner
sciece Edir:
Key Macom
Deiger:
Vanessa DeJongh
Iide olie Edir:
 Bi Stagg and Erin PrattCopyright © 2009Duke University Heath SystemInside Duke Medicine, the empoyeenewspaper or the Duke University HeathSystem, is pubished monthy by DukeMedicine News & Communications.Your comments, story ideas and photocontributions are aways wecome andappreciated. Deadine or submissionsis the 15th o each month.
the key  ccewa eamwrk
orward,” said William J. Fulkerson, Jr., M.D., senior vice president orclinical aairs. “The really impressivething that emerged in this project wasthe collaboration between physicians,nurses, managers and a host o othersto achieve the goal.”Achieving, and in act exceeding,the target in this project has been aremarkable eat, considering that theteams sent out to nd the savings andrevenue were given two principlesto ollow strictly as they combed theorganization looking or opportunities— don’t aect the workorce and don’tdo anything that would weaken patientsaety or patient care.This expense management initia-tive was important or at least twosignicant reasons. First, the resultswere elt to be what would be neededto oset anticipated potential uturereimbursement reductions. Second, inosetting potential threats to operatingincome, it better positioned the organi-zation to consider decisions regardingmajor capital investments in our uture.“We must have the resourcesnecessary to build a oundation orgrowth,” Fulkerson said. “And it’simportant that we work to eliminatebarriers to our growth potential orpossible risks o impact to the healthsystem workorce, the people who areresponsible or Duke’s tremendoussuccess and reputation.”There were three primary actorsthat suggested that the project wasnecessary, said Ken Morris, the healthsystem’s senior vice president, chie nancial ocer and treasurer.First was a growing belie withinthe American health care industry thatgovernment reimbursement programshad reached their peak and that in aew years Congress, struggling withgrowing budget decits, would do asit had done in the past and cut reim-bursements to health care providers.Second, Morris said, were thehealth system’s growth plans, whichlike with any building projects, wouldrequire signicant capital duringconstruction and rst ew years o operation. Health system leaderswanted to make sure that there wasmore than enough resources or currentoperations and expansion expenses.And third was a body o growingevidence that the U.S. economy wascooling down and that credit marketswere entering a period o turmoil.“Considering our estimates o government reimbursement reductions,our uture growth needs and wantingto be prepared i the global economybecame more certain, we came up witha target gure we thought we couldachieve over the next two to three scalyears,” Morris said.During the process, priorities wereweighed — it was about more thansimple cost cutting. It was about mak-ing the health system operate better.For example, one team lookedat hundreds o devices and productsthat are used in procedures in thehealth system’s hospitals — romlinens to laboratory materials tosurgical needs and beyond.Working together, acultyphysicians and procurement ocersmake strategic choices o goods thatprovided the same or better service,but at lower cost.Another team, ocused on revenueenhancement, also ound success.A team at the Patient RevenueManagement Organization workedhard to determine Medicaid andMedicare eligibility o patients and toreduce write-os and bad debts.“This project was not just expensereduction; it was also revenue enhance-ment,” Fulkerson said. “The goal withrevenue enhancement was to make surethat we are being paid what we aresupposed to be paid or providing careto our patients.”Savings were ound in other areas— the ongoingswitch-overto Internettelephone andaggressiveeorts to reduceenergy con-sumption will together save more than$2 million when ully implemented.As part o the cost-saving eort,some vacant positions were eliminated.The eort to nd ways to improveDuke University Health System is aproject without an end date.“I like to remind people that thisis not ‘one-and-done,’” Fulkerson said.“Expense management and revenueenhancement have got to be corecompetencies or us, and we are reallygetting there. For example, I am veryproud o the way the hospitals work onexpense management. Now, we’ve gotto take it to the next level.”
n
PREPARED, cied
“Exense mnement nd evenueenhncement hve ot to be coe cometencieso us, nd we e ell ettin thee.”
— Willim J. Fuleson, J., M.D., senio vice esident o clinicl is
Phyicia, re, maager ad her cllabraed  help DuHs leader  ayem-wide expee maageme iiiaive.
IlE PHOTO
It was teamwork every step o the way.As part o the expense management initiativeover the ast year, teams o physicians andhospita administrators worked together toidentiy miions o doars in savings byexamining how much the heath system paysor the suppies it buys reguary.Just as in a critica examination o a househodbudget, it’s not easy to cut expenses by buyingsomething with a dierent price.Consider just one area that was examined —surgica suppies. Not every medica deviceworks the same. There are honest dierencesabout which devices ead to the best outcome.To ensure a interests were heard — and thatensuring quaity patient care remained the toppriority — the eort in this area coud not be atop-down process.Physicians partnered with procurement ofcersto examine a ong ist o dierent suppies anddevices, and deveoped a strategy or makingchoices that maintained quaity care but asoproduced savings.“We went case-by-case, working right aongwith the physicians,” said Jane Peasants,assistant vice president or procurement andsuppy chain management.Working with Peasants was Steven A. Oson,M.D., chie o the Section o OrthopeadicTrauma , chairman o the PerioperativeExecutive Committee, and chie medica ofcero Duke University Hospita.“The key was sharing data,” he said, “andthen examining it together.”Data was shared on the patient outcomes,days o treatment, tota spending on an itemand spending per patient. It was an intensiveeort to see what things reay cost and whatresuts were reay gained. With that inorma-tion, the group, together, was abe to makedecisions about which makes o items— romspina impants to joints to impantabe cardiacdevices — Duke acuty physicians woud useand which they woud not.The choices made aso ft into the arger goa onegotiating with vendors and suppiers to getthe best possibe price or those items.Whie data and eective negotiating skis didtheir part, Oson and Peasants credit teamworkor the success o the project.“A ot o peope had ownership in thisprocess,” Peasants said. “That made thedierence.”
n
 
3
May 2009
Iide Dke Medicie
unding
schl  Medicie cr iml dig
each year,” said Victor J. Dzau, M.D., presidentand CEO o the heath system. “And, thiscommitment is never more important than ata time when so many peope throughout ourstate are being negativey aected by thisgoba economic crisis.”Approximatey $141 miion o the $229miion tota e under the ederay defnedcategories o community beneft, whichincude urgent or emergent heath careservices provided at a discount or no cost topeope in fnancia hardship, Medicaid programosses, direct support o community heathorganizations and the training o heath careproessionas in our hospitas and cinics.In addition, DUHS aso absorbed Medicareprogram osses and unrecoverabe patientdebt, which together totaed $88 miion.Just one part o these eorts, Duke’s supporto community heath organizations, aectstwo dozen community heath programs thatprovide ow-cost cinica services to more than11,000 peope. Among these is Duke’s directand in-kind support o lincon CommunityHeath Center, a ederay quaifed aciitywhich serves an overwhemingy poor and un-insured popuation in Durham.Additionay, Duke supports primary carecinics in the lyon Park and Watownneighborhoods in Durham, operated in co-aboration with lincon. Duke wi do ikewiseat the uture Hoton Career and ResourceCenter, and in addition has provided supportor design and construction.Duke aso unds and operates weness centersin the George Watts, Genn and E.K. Poweeementary schoos and at Southern HighSchoo in Durham.Duke speciaists have made a commitment toheath care access through their participationin the Project Access programs in Durham andWake counties. Through Project Access, Dukeacuty physicians donate their time and ex-pertise to provide the uninsured with speciatycare. The Durham County program grew out oDuke’s direct coaboration with Durham com-munity eaders.To communicate these eorts to the com-munities we serve, the heath system hasrecenty summarized its commitment tocommunity beneft in a new pubication thatwi be shared with eected ofcias andcommunity eaders. This report wi be madeavaiabe eectronicay to empoyees and thepubic at arge in coming weeks.“Duke University Heath System is committedto providing a ree care program that exceedsindustry standards and one that we shoud beproud o, as an organization,” Dzau said.
n
CARE, rm r page
In 2008, Due UnivesitHelth Sstem ovideduncomensted ce ndothe diect communitbenefts vlued t$229 million.
W
hen President Barack Obamasigned the American Recoveryand Reinvestment Act o 2009 on Feb.17, the National Institutes o Healthsuddenly had an extra $10.4 billion instimulus research unding to share out.That has set o a mad dash, asresearch institutions across the countryscramble to submit research ideasthat can create or retain jobs in thisdepressed economy.The response here at Duke has beenimpressive, said Mollie Sykes, associatedean or research administration,pointing to more than 200 ChallengeGrant proposals that Duke aculty havealready submitted, in addition to 100proposals or supplemental undingor NIH grants previously awarded toDuke investigators.“This represents a ourold increasein the number o NIH grant applica-tions we normally process in a givenNIH grant cycle at Duke,” said Sykes.And, at least 30 Duke investigatorshave been notied by the NIH that theirpreviously submitted but unundedproposals would now be receivinggrants through the ARRA stimulus.On top o all this increasedactivity is the pressure to meet astdeadlines, as NIH, the NationalScience Foundation and other ederalagencies strive to get the stimulusdollars into the national economy asquickly as possible.Meanwhile, Sally Kornbluth, Ph.D.,vice dean or basic science, and otheruniversity leaders have been coordinat-ing submissions or equipment grantsand major renovation and constructionproposals – each institution is limited inthe number they can submit – to avoidoverlaps and acilitate separate projectsmoving orward.“We are developing proposals ormajor renovation and constructiongrants that will greatly improve theSchool’s inrastructure, augmentanimal housing and procedure spacesand upgrade and enlarge our labora-tory ootprint,” said Kornbluth.The School will submit moreequipment grants this year than in thepast ve years put together.Over the last several years, theNIH has unded just 20 percent o the grant proposals it receives. Duke’slarge number o stimulus-relatedproposals is the right way to competeor ARRA unding, said Sykes.“The aculty are making greateorts to take advantage o thestimulus unding opportunities,” saidScott Gibson, executive vice deanor administration. “The universityadministration is mobilizing to makesure these grants are submitted in anecient manner and that aculty knowthat once the unds are awarded they’llhave the appropriate help in meetingall o the new reporting requirements.”Similarly, Duke University HumanResources has launched a numbero strategies to address the emergingunding, including the creation o apool o qualied internal and externalcandidates or the research, technical,and clerical support positions that areexpected to be created through stimulusunding. New jobs will be posted at
 
http://www.hr.duke.edu/jobs/stimulus/
.All ARRA stimulus grants willrequire quarterly reporting to the gov-ernment to track the number o jobsretained and created, as well as otherbenets to the economy. Jim Luther,assistant vice president or researchCSTG compliance, has worked closelywith the Council on GovernmentalRelations to urge the NIH to notmake these reporting requirements tooburdensome on investigators.Even beore the stimulus plan wasproposed and passed, Duke adminis-trators had been working to revampthe research grants administrationprocess that coordinates all researchunding that comes to Duke. TheResearch Administration ContinuousImprovement (RACI), an initiativebegun in 2007, involves Universityand School o Medicine senior leader-ship and aculty and sta advisorsin eorts to make administrativeunctions as ecient as possible andinvestigator-riendly.“This initiative was designed tohelp all researchers, and it has put usin very good condition to react to theARRA economic stimulus on veryshort notice,” said Gibson. The RACIcommittee, currently ocused on thestimulus preparations, recently launcheda central Web site or all Duke-relatedARRA inormation and resources, at
http://stimulus.ors.duke.edu
.The committeealso created anARRA ResponseTeam that canassist any Duke investigator with anyquestions, institutional support lettersor concerns about large-scale propos-als. Reach that team at 660-2772 or
ARRA@duke.edu
.All stimulus grant unding mustbe spent within two years, saidGibson, and ARRA is only a short-term shot in the arm.“Duke is doing as much as possi-ble to take advantage o the undingopportunities,” he said. “We knowthat the NIH unding crisis has notgone away.”
n
Dke' er  repd  he ecmic iml dig are deailed a
p://l...
.
The cult e min et eotsto te dvnte o the stimulusundin ootunities.
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...