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Healthcare 2011

Healthcare 2011

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Published by: kokomonews on Mar 25, 2011
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Howard Regional up to the challenge
Healthcare reform brings sweeping changes to theindustry; hospitals will form the core of the new system
he components of the healthcare re-form bill are gradu-ally taking effect.According toHoward Regional Health Sys-tem chief executive officerJames Alender, understandinghow they willaffect the hos-pital andhealth care ingeneral is thechallenge.“First, weneed to un-derstand howaccountablecare organiza-tions will roll out on a statewidebasis,” said Alender. “The nextphase is value-based purchasingand the process of paying forquality versus quantity. Finally,there are some definitive newregulations related to not-for-profit hospitals providing char-ity care to the communities theyserve.”
Accountable care
When it comes to account-able care, Howard has directedits energies to a massive $22million conversion to electronicmedical records. Alender ex-plained that all healthcareproviders will be required tomaintain electronic records by2015 or face reductions inMedicare reimbursement. Thehospital is well ahead of thecurve in this regard.“We have a June 13 go-livedate on this project, and we areusing a house-wide conversionmethod, or ‘Big-Bang Theory,’”said Alender. “All of the recordswill go live at one time.“There is stimulus money inthis project. Based on the vol-ume of Medicare business wedid in 2008, there is $3.1 millionof stimulus money in the proj-ect. That doesn’t cover thecosts, however, it helps us get toour goal.”Electronic medical recordswill significantly alter thehealthcare landscape, Alenderbelieves. It allows for portabil-ity and access of information,which is particularly importantfor people who follow theweather south for the winter.“This is the right thing to dofor our patients,” said Alender.“Kokomo people who are snow-birds need to have access totheir medical records, no matterwhere they are. This will allowthat. And in the end this will re-duce healthcare costs. It will re-duce duplicity and excessordering of tests.”With the records digitallymaintained, a patient can bemoved through the systemmore efficiently, meaning lesstime in the emergency room inacute cases. It also means thatthe same patient will have anadvantage should similar symp-toms arise a few weeks laterwhile away from home.“The next hospital managingyour care will be able to pull upyour records and see how youwere managed so they don’t re-peat what didn’t work,” said Al-ender.But electronic medicalrecords won’t be a cure-all.
by Patrick Munsey 
staff writer
t seems that a lullabyplays every 10 minutes inthe hallways of St. JosephHospital. CEO KathyYoung smiles every timeshe hears it for a couple of rea-sons. First, it signifies that an-other baby has been broughtinto the world. And second, ittells her that business is good.In fact, business is boomingat St. Joseph. The hospital hasbeen running at or near full ca-pacity for most of the month.That’s not necessarily unusualfor March. Young explained thatthe seasonal change from win-ter to spring seems to bring peo-ple out of doors, chocked full of illnesses and injuries. But thisyear seems a bit different fromthe last few.“Our people are working re-ally hard to make sure everyoneis taken care of,” said Young.“It’s very busy. It’s a great prob-lem to have, even if there isn’talways an easy solution. I getthe feeling that confidence inthe economy is coming back.You can’t say it is healed yet, butconfidence has returned. Peo-ple are accessing care again.Our charity care is leveling off.But things continue to be chal-lenging. I feel good about the di-rection our community is goingin terms of bringing new jobsand in how we present our-selves to potential businesseslooking to land here. For us, themost important thing is that lev-eling off of charity care. We’reable to manage where we are.”As the CEO of one of thelargest and most important em-ployers in the community,Young realizes that St. Josephhas a special role that manymight overlook. It is a majorplayer in the economic develop-ment arena. And it is one of thegreatest assets Kokomo andHoward County has to offer.“Health care is a huge con-cern for employers,” saidYoung. “They want to knowthey have first-class, high-tech,quality care close to home. Butthey also want to have a say inhow health care is delivered.Our ability to provide healthcare is a big deal to potentialbusinesses. Does that help eco-nomic development? Ab-solutely. We have valuable inputinto how the community movesforward.“We want to be a part of thepositive message in the commu-nity. We have been able to addto it. We are proud of being oneof Indiana’s best places to workfive years in a row. That’s awe-some. The first couple of yearsis exciting, but to continue it forfive years ... we have peoplebegging to work here.“Several years ago, we wereout there advertising like crazyto get nurses and healthcareworkers here. Now we havepeople calling every day, tryingto figure out how to get a jobwith us. What a great feeling
St. Joseph a catalyst for change in Kokomo
Hospital flexing its muscle as an economic development tool, featuringtop place to work, improved technology and community-level care
Colorectal cancer ispreventable, treatable– provided you haveregular colonoscopies
by Lisa Fipps
managing editor
he best way to screen forcolorectal cancer is witha colonoscopy. HowardRegional Health System’sDr. John Salter, a medicaloncologist and hematologist, justcan’t say it any plainer than that.March is Colon Cancer AwarenessMonth, and it brings to mind a body partthat a lot of people don’t like to talkabout.“People will occa-sionally pass blood intheir stool – and I’mnot talking about goingto the bathroom andwiping and findingsome blood on the toi-let tissue, which is usu-ally minor bleedingfrom hemorrhoids ordiverticulitis, but I’mtalking about where the water in thebowl turns red with all the blood – forweeks or longer before seeking medicalattention because they’re so embar-rassed about talking about their bowelmovements,” said Salter. “The colon isdirty. It excretes waste. There’s a lot of negative connotation to it.”“What upsets me is colon cancer’svery treatable,” Salter said. “It’s pre-ventable if caught early.”Someone who dreads talking to adoctor about bowel movements, thecolon and rectum and fear having acolonoscopy should consider the alter-native: Polyps can become cancerous,possibly leading to surgery, chemother-apy, radiation and excreting wastethrough an ostomy bag.“It’s terrible to think that a patientwill be forced to use an ostomy for therest of his or her life when this outcomeis potentially preventable for most pa-tients,” Salter said.Because a person is given general se-dation, it’s not painful to undergo acolonoscopy.During the colonoscopy, a gastroen-terologist or surgeon (depending on thepatient’s choice) will remove any polypsand perform any needed biopsies.“The great thing about a colonoscopyis we can find anything and remove itright there and then,” Salter said. “That’swhy having a colonoscopy is so impor-tant. If a polyp is precancerous, we canremove it before it becomes cancer.”Left undetected and untreated, coloncancer can spread to other organs, in-creasing a person’s chance of dyingfrom the disease.Some colon cancers are genetic, justlike with breast cancer.According to the American CancerSociety, “Genetic tests can help deter-mine if members of certain families
AlenderDr. Salter
Howard Regional HealthSystem Oncology Serviceswants to encourageeveryone who is at risk forcolorectal cancer toreceive an occult blood testduring March, ColorectalCancer Awareness Month.The test is easy and can bedone in the privacy of yourown home. The results willbe processed by HowardRegional and returned to youvia U.S. Mail. If you are over50 or have a family history ofcolon cancer, please pick upyourFREEcolorectalscreening kit at HRHS’sOncology Center on the westside of the main campus at3500 S. Lafountain St. Formore information, pleasecall 453-8571.
by Patrick Munsey 
staff writer
Our people areworking reallyhard to make sureeveryone is takencare of. It’s verybusy. It’s a greatproblem to have,even if there isn’talways an easysolution.
Kathy Young,
MS, FACHE,president,St. Joseph Hospital
Photo by Morgan Young
When it comes to accountable care, HRHS hasdirected its energies to a massive $22 millionconversion to electronic medical records. Allhealthcare providers will be required to maintainelectronic records by 2015. Howard Regional iswell ahead of the curve in this regard.
Health Care
Kokomo Perspective March 23, 2011
There still will be inefficien-cies and duplication in thesystem. The compromised,reworked version of health-care reform is missing a keyprotection for the industry.“What did not happen wasthere was no relief of tort li-ability,” said Alender. “Theconsequences of that, de-spite the fact that Indiana isa great state for physiciansbecause of its malpracticefund, is you still find defen-sive medicine being prac-ticed, particularly in theemergency room.”
With reforms pushing theindustry toward preventa-tive care, there should befewer patients in need of acute care, which meansless income for hospitals. Inessence, a hospital will beencouraged to work againstits traditional bottom line byaddressing concerns beforethey progress to the hospi-tal’s level of care.“Value-based purchasingwill be a real change in thehealthcare arena,” said Alen-der. “Hospitals have alwaysbeen paid by volume. We’rebeing legislated into beingpaid for quality. If we do avery good job of managingwellness at the primary carelevel, we should see less vol-ume, which means the hos-pital will see less in-patientadmissions.“Consequently, there willbe further consolidation inthe industry. We all believethat we should be paid fordoing it right, so we feelcomfortable with that.”Already, hospitals andcare providers are forminglarger networks to ensure afull continuum of carewithin a given system. In thisstructure, hospitals will findthemselves in a unique rolewhen it comes to Medicarereimbursement.“The next step will bebundled payments, whichwill be rolled out in 2014,”said Alender. “It puts theprovider, the hospital, in theposition of receiving thepayment for the physician’sprofessional services, thehospital’s technical servicesand room and board, and theextended care facility’s serv-ices when applicable.“Bundled payments makeus responsible for disburs-ing the payment, which en-courages continuity of care.The result will be integrationbetween the hospital and thephysicians and extendedcare facilities. It’s happeningnow.”
Charity care
Primary care providers al-ready are in high demand asthe healthcare industrygears up for consolidation.Howard Regional currentlyhas 40 physicians under con-tract in its network and issearching for more. Andwith good reason. The thirdaspect of healthcare reform— access for all — will behere before you know it.“It’s still not known howthe 32 million previouslyuninsured people will behandled,” said Alender. “Weall gave up millions in futureincreases from Medicare,believing that these peoplewould get something underthe reform act. We need tosee that come together.“Then we need to knowwho will manage all of thesepatients. I have a real con-cern once these people haveaccess to care. The ER is themost costly form of medicaltreatment. Our plan is tooffer urgent care centers.We have one planned toopen in July. I think you’llsee management at a loweracuity instead of allowingthem to come to the ER.”With a glut of patients hit-ting a system already shortof service providers, it willbe important for people toeducate themselves on theservices provided and theirspecific healthcare needs.Alender believes that thehospital will play a key rolein that process.“More and more con-sumer education and re-sponsibility is falling to thepatient,” said Alender. “It’sup to them to look at the sys-tem and the providers andsee who they are alignedwith. It’s our job to providethat education. It’s becom-ing very complex and morerestrictive and financiallydetrimental to go out of net-work for treatment.“The patient has to takeownership of his or herhealth care. Second, the em-ployer needs to understandthe health plan it provides.The third part is up to us tohelp them understand theservices provided by thehospital.”
continued from page
have inherited a high riskfor developing colorectalcancer due to syndromessuch as familial adenoma-tous polyposis (FAP) orhereditary non-polyposiscolorectal cancer (HNPCC).Without genetic testing, allmembers of a family knownto have an inherited form of colorectal cancer shouldstart screening at an earlyage and get screened fre-quently. If genetic testing isdone for a known mutationwithin a family, those mem-bers who are found not tohave the mutated gene maybe able to be screened atthe same age and frequencyas people at average risk.“When looking atwhether testing might beappropriate, a genetic coun-selor will try to get a de-tailed view of your familyhistory. For example, doc-tors have found that manyfamilies with HNPCC tendto have certain characteris-tics:•A least three relativeshave colorectal cancer.•One should be a first-de-gree relative (parent, sib-ling, or child) of the othertwo relatives.•At least two successivegenerations are involved.•At least one relative hadcancer when that personwas younger than age 50.•Tumors should be veri-fied by pathologic examina-tion.”For more informationabout FAP and HNPCC(Lynch Syndrome) go to theAmerican Cancer Societywebsite, www.cancer.org.While a person cannotcontrol genetic factors,there are some lifestylechanges people can make topossibly help prevent col-orectal cancer.“Diets high in vegetablesand fruits have been linkedwith lower risk of coloncancer,” according to theACS. “Diets high inprocessed and/or red meatshave been linked with ahigher risk. The AmericanCancer Society recom-mends that you eat ahealthy diet, with an em-phasis on plant sources.This includes the following:•Choose foods and bever-ages in amounts that helpachieve and maintain ahealthy weight.•Eat five or more serv-ings of a variety of vegeta-bles and fruits each day.•Choose whole grainsrather than processed (re-fined) grains.•Limit your intake of processed and red meats.”“The theory is that withmore fiber in your diet, anycarcinogens will have lesstime to have contact withyour colon wall,” Dr. Saltersaid.“Avoiding excessive alco-hol intake may also helplower your risk of colorec-tal cancer,” according to theACS. “The American CancerSociety recommends nomore than one drink per dayfor women or two per dayfor men. Physical activity isanother area that you cancontrol. The American Can-cer Society recommendsthat adults get at least 30minutes of moderate or vig-orous physical activity onfive or more days of theweek. Moderate or vigorousactivity for at least 45 min-utes on 5 or more days of the week may lower yourrisk for colorectal cancereven more. Obesity raisesthe risk of colon cancer inboth men and women, butthe link seems to bestronger in men.”Salter pointed out thatthere is some data that sug-
continued from page
Colon cancer is the third most common cancer di-agnosed in both men and women in the United States.It is also one of the most preventable. Men and women50 and older are encouraged to make getting tested forcolorectal cancer a priority by contacting their physi-cians and scheduling a colonoscopy.Signs and symptoms of colorectal cancerDr. John Salter, a medical oncologist and hematolo-gist at Howard Regional Health System’s OncologyCenter, notes that oftentimes with colorectal have nosymptoms and that symptoms can surface after it’s ad-vanced.Colorectal cancer may cause one or more of thesymptoms below. If you have any of the following youshould see your doctor:A change in bowel habits, such as diarrhea, consti-pation, or narrowing of the stool, that lasts for morethan a few days.A feeling that you need to have a bowel movementthat is not relieved by doing soRectal bleeding, dark stools, or blood in the stool(often, though, the stool will look normal).Cramping or abdominal (belly) pain.Weakness and fatigue.Unintended weight loss.Most of these symptoms are more often caused byconditions other than colorectal cancer, such as infec-tion, hemorrhoids, or inflammatory bowel disease.Still, if you have any of these problems, it's importantto see your doctor right away so the cause can be foundand treated, if needed.
Source: American Cancer Society
Symptoms ofcolon cancer
gests that NSAIDs (nons-teroidal anti-inflammatorydrugs), which includes as-pirin, may reduce the for-mation of polyps. That’ssomething you should talkto your doctor about. Somepeople should not be on as-pirin therapy; others can be.Anemia in men and post-menopausal women is a bigred flag, Salter said, so thatthe person needs to have acolonoscopy.“Iron-deficiency Anemiais not a normal findingamong American adults,given that the typical Amer-ican diet should provide ad-equate amounts of iron,”Salter said.and reassurance that we’removing in the right directionand taking care of people.”Being named one of thebest places to work in thestate not only helps withbusiness attraction andmaintaining full employ-ment, but it also aids thehospital in physician recruit-ment — a major concern ashealthcare reform pusheshospitals and primary careproviders to consolidate intohealthcare systems.“It is a huge help in re-cruitment,” said Young.“Physicians want to knowthat they will be workingaround quality profession-als. Recruiting is getting eas-ier and easier. The hard partfor all hospitals is that pri-mary care recruitment istough. There is huge de-mand in anticipation of thecovered lives that will comewith healthcare reform. It ishighly competitive. Familypractice, internal medicine,pediatrics — they are verycompetitive. We feel we canput a great face forward.”Over the past year, St.Joseph has taken a “behind-the-scenes” approach to im-provement of services.Rather than build a new fa-cility or start a new spe-cialty, resources werereinvested in the hospital’sexisting services and tech-nology. Young is pleasedwith the results.“We went back to makesure all of our equipment wehave is as up to date as pos-sible,” said Young. “We’vemade sure our monitoringsystems are the latest andgreatest. We’ve worked inthe OR to bring in a newlighting system to help withsurgical procedures. Nowwe’re starting to plan for ex-pansion of programs.“We are moving towardobtaining the best technol-ogy available for the earlydetection and treatment of breast cancer. This year weupgraded our detection serv-ices through MRI to makesure we have the most re-cent technology. Those partsare coming together to offera center of excellence forbreast care. Then, we’ll takeit to the next level, centeredaround convenience and ac-cess. We upgraded our tec-nology so we get a moreclear picture. The tumors wecan pick up are very small,which is where we want tocatch them, while they arestill highly treatable. This al-lows us another level of clar-ity.”St. Joseph also has an eyeon how society prefers toconsume health care today.Young explained that pa-tients want access to healthcare as close to home aspossible. Driving for miles tosee a specialist or even justacross town to a primarycare provider is becomingan impediment to the deliv-ery of care. The hospital isseeking to overcome thehurdle with the implementa-tion of walk-in communitycare centers. With the recentopening of a facility in DixonPlaza, St. Joseph now hasthree primary care centers.
(See “Westside St. VincentPhysician Network practicerelocates to facilitythat will improve patientcare”on page D4.)
continued from page
Health Care
March 23, 2011 Kokomo Perspective
Behind-the-scenes caregivers play big role in health care
hen youthink of St.Joseph Hos-pital, youthink of doc-tors and nurses. But thereare more behind-the-scenescaregivers (669) than thereare doctors (157) and nurses(260) combined, and thosebehind-the-scenes care-givers have an equally im-portant role to play when itcomes to taking care of pa-tients.
Working 24/7/365 are thefolks who can performabout 700 different proce-dures in chemistry (findingout the patients’ glucose,cardiac enzymes, creatinine,bilirubin, etc. levels), hema-tology (checking blood), mi-crobiology (studying avariety of specimens),pathology (examining tis-sues) and coagulation (as-sessing how blood clots),said Gail Greene, director of the lab.Quality control is para-mount. For example, when aphlebotomist is drawingblood for a variety of tests,tubes must be filled in a spe-cific order because the nee-dle which pierces the tubescan carry additives from onetube to the next, resulting incross-contamination and in-accurate results.Some tests have to bedone within minutes of ablood draw or there couldbe inaccurate results.“For some patients, weshouldn’t draw from onearm,” said Sandy Herman,director of marketing. “Gailand her staff are very goodabout making sure every-thing’s done right.”“The results we give affecta patient’s treatment,”Greene said. “That’s why thelab has always been very an-alytical with very high stan-dards of quality.”Accuracy is also crucialbecause doctors also use labresults to reach a diagnosis.“You can come to the hos-pital with a pain in yourside,” said Mary Beck, atechnologist in the lab.“There can be a lot of rea-sons for that. Testing givesthe doctor clues, a directionto go to figure out what’swrong.”Greene noted the hospi-tal’s blood bank is also partof the lab and is AABB ac-credited; AABB promotesthe highest standard of carefor patients and donors in allaspects of blood banking,transfusion medicine,hematopoietic, cellular andgene therapies, transplanta-tion, and relationship test-ing.
Shelly Wood, manager of material services, and herteam order and distributeseveral hundred thousanditems a year to make surethat the various departmentshave all that they need toprovide the best care for pa-tients.“We provide the rightitems in the right amount tothe right places at the righttime,” she said. “We treat thehospital staff and all the de-partments as our customers.When they need something,we need to respond.”Material services deliverssupplies to the departmentsall week long and checksstock to ensure that prod-ucts that are about to expireare removed and not used.About nine months ago,St. Joseph Hospital beganordering items out of St. Vin-cent’s warehouse in Indi-anapolis; buying in bulkallows the hospitals in thesystem to receive the itemsthey need for less money.“Some people think theyhave to go to Indy for healthcare, but we have the sameitems they have,” Wood said.
Connie Peach, manager of environmental services, andher team provide care to pa-tients by providing a clean,pleasant environment inwhich they can heal.The staff of 45 provideshousekeeping, floor care,linens, setup for meetings inconference rooms, includingpreparing AV equipment,valet service, and selectionof colors when it comes tothe interior décor.“Our main focus is safety,infection control and elimi-nating cross-contamination,”she said. “Our staff has to betrained. For example, somecleansers will not kill certaingerms, so our housekeepershave to know which prod-ucts to use in each area of the hospital. Plus they needto be trained to properly usepersonal protective equip-ment. Even simple things,like pulling a bag out of trash, has to be done in aspecific way.”Herman noted that house-keeping even provides softersheets without wrinkles –wrinkles can be painful for apatient with fragile skin. Thedepartment is
detail-ori-ented when it comes to care.“Our staff is also goodabout talking with patientswhen they’re in their roomsto clean,” Peach said. “Theyoften do little things, likemake sure a tray is close by,or provide an extra pillow,so patients don’t have to aska nurse to do that.”“That allows nurses moretime to focus on patients,”Herman said.
Being in a hospital isstressful to patients andtheir loved ones. That’swhere Marcia Jewsbury, co-ordinator of Workplace Spir-ituality and Planetree at St.Joseph Hospital, comes in.She ensures chaplainswho serve all faith traditionsare available 24/7 to comfortthe sick, to support theirloved ones, and to educatepatients and their loved onesabout advance directivesand end-of-life care. “Wehave great respect and rev-erence for people’s reli-gions,” Jewsbury said.Twice a week, a priestprovides mass. Chaplainsare there to pray for patientsand their loved ones. “Wefocus on the spiritual sidewhen there’s a crisis,” suchas a wreck, a death, a crimevictim, or an accident victim,she said.But Jewsbury and the oth-ers on her team know thatthe hospital workers face alot of stress, too.“We have prayer serviceswhen we have a crisis, like astaff death,” Jewsbury said.“We do stress debriefingafter a crisis.” For example,doctors and nurses mayhave to treat crime victimsand the perpetrator. Doctorsand nurses can go emotion-ally numb so they can stayfocused mentally on the taskat hand in order to take careof the patients in crisis, butafter it’s over, they need todeal with what’s happened.Again, that’s when Jewsburyand her team step in.
Food and nutritionservices
Good food is essential tostaying healthy and support-ing the healing process, soChaoch Seidensticker, man-ager of food and nutritionservices, and his team carefor patients and staff by pro-viding healthy, fresh foodthat’s also convenient.Dietitians provide inpa-tient and outpatient assess-ments, teaching those withspecial dietary needs orhealth issues how to makethe best choices.At St. Joseph Hospital, apatient can order a meal orsnack any time, day or night.That’s important to provid-ing the best patient care be-cause, for example, if apatient’s been sick duringthe night, breakfast mightnot sound so good at 7 a.m.,but the person could be feel-ing better and hungry by10:30 a.m. A patient’s lovedcan also order a meal for asmall fee, which is helpfulbecause many times a lovedone doesn’t want to leavethe person who is sick.Unless a diet is restricted,a patient can order a varietyof foods, including Asianstir-fry and pizza.St. Joseph provides sevendifferent menus, including aliquid diet, a renal diet, a di-abetic diet and a normaldiet. That means a patienton a low-sodium diet, for ex-ample, doesn’t see the foods
by Lisa Fipps
managing editor
At St. JosephHospital, welive by the phi-losophy thatevery memberof our team isa caregiver.
director ofcommunications
Chaoch Seidensticker, manager of food and nutrition serv-ices,
and his team prepare a variety of items for the St. Joe
and employees oftenget takeout to take home to their families.

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