Becker's Hospital Review

Save the date! Becker's Hospital Review 6th Annual Meeting — May 7-9, 2015 — Chicago. Please call 800-417-2035 to register. 52 W hen José R. Sánchez arrived at Chica- go's Norwegian American Hospital to serve as president and CEO in Octo- ber 2010, the hospital was struggling to stay afloat. Norwegian American, which serves a predomi- nantly Medicaid and a poor Hispanic population in the Humboldt Park neighborhood, had its fi- nances in the red. The hospital's payer mix is 31 percent Medicare and 55 percent Medicaid, with just 1 percent of patients having commercial in- surance. It had been under surveillance by CMS for several years for quality and safety issues and was on the verge of losing its Joint Commission accreditation. Records were still kept by pen and paper, physician engagement was weak and there was no relationship with the community. Unlike most hospitals and health systems in the Midwest, Norwegian American is also challenged with future immigration reform, as high concen- trations of undocumented immigrants who are not eligible for insurance seek medical care from the hospital. Mr. Sánchez, who at the time was senior vice pres- ident of the Generations+/Northern Manhattan Health Network, one of the largest healthcare net- works in the New York City Health and Hospital Corporation, saw Norwegian American as an op- portunity. He could make a mark on his profes- sional career, he explained, but he also felt a bigger connection to Chicago as a city. "Sometimes professionally you find yourself at the right time and the right age to move and take different challenges," he said. Upon his arrival at Norwegian American, Mr. Sánchez immediately set up his vision for the hospital's turnaround. This included improving quality, stabilizing the hospital's finances, engag- ing physicians and the community and imple- menting an EMR. First step: Realizing the importance — and power — of the community Perhaps no other element of Mr. Sánchez's vision was as immediately critical to the hospital's sur- vival as engaging the community, especially when he learned the state of Illinois was planning to cut $2.6 billion from Medicaid, the source from which Norwegian American's revenue largely de- pended. "This was probably the most complex time dur- ing the period I arrived here. Here I am in charge of the hospital that is dealing with so many prob- lems, and now I'm also dealing with a financial crisis at the state level," Mr. Sánchez said. As a safety-net hospital, the residents of Hum- boldt Park depend on Norwegian American to deliver their healthcare, but furthermore, the hospital serves as an economic anchor. Nearly 75 percent of the Norwegian American Hospital em- ployees are from the community. Confronted by a seeming insurmountable hurdle, Mr. Sánchez became more than a CEO, he be- came a community organizer. He earned the sup- port of the community, developed good relation- ships with elected representatives and even bused people from the neighborhood to Springfield to lobby for the safety net-hospital. Community members accompanied Mr. Sán- chez and CEOs from other Chicago safety nets, including St. Anthony's and Mercy Hospital, to testify in front of the Chicago City Council Com- mittee on Health and Environmental Protection. Together, they conveyed the impact the Medicaid cuts would have on the hospitals, and their voices were heard. In 2012, the final Medicaid budget bill, called "Save Medicaid Access and Resources Together," or the SMART Act, spared safety-net hospitals from proposed provider reimbursement cuts. The provisions of the SMART Act outlined specific demands for safety-net hospitals to re- duce costs. "This state reform challenged us as a system to look for opportunities to make things better fi- nancially through improving quality and looking at efficiencies. At the time, we didn't have a choice, but it was the right thing to do for our patients," Mr. Sánchez said. Improving quality and safety paved the way Norwegian American's quality transformation set the groundwork for the hospital's turnaround. Abha Agrawal, MD, joined the hospital as CMO in 2012 and has played a significant role in driving Norwegian American's quality journey. The hospital has made a significant investment of resources in technology focused on improv- ing patient safety and clinical quality. Under the direction of Mr. Sanchez and Dr. Agrawal, Nor- wegian American has implemented a full-scale EHR in the inpatient and physician practice set- tings. Successful attestation to meeting meaning- ful use requirements has been accomplished in both areas. Further adoption of patient safety- focused technology includes computerized physi- cian order entry, digital transcription capability, clinical decision support software and bedside barcode automated medication administration. Additionally, a robust disaster recovery and busi- ness continuity plan was implemented, and the hospital has taken a leadership role in a Chicago- based health information exchange. Since 2010, Norwegian American has invested more than $5 million in capital funds and currently allocates 7 percent of its annual operating budget to infor- mation technology. From 2012 to 2013, the hospital's Leapfrog quality scores improved by 235 percent from 20 percent to 67 percent, placing it 14 percent higher than the na- tional average, and its resource use score improved by 408 percent, 2 percent above the national average. "This component of running a hospital has been critical for the turnaround," Mr. Sánchez said. "If you don't provide good quality care, then it's hard to attract patients to come to you, physicians to refer to you and it's even hard to attract hospital staff." When a hospital's quality is good, he explained, there are several interconnected effects. Referring physicians have confidence that they are sending their patients to a trusted organization, and this keeps both the medical providers and patients sat- isfied. And word-of-mouth is still the best form of advertising — according to Mr. Sánchez, people sharing their positive experiences in the commu- nity has significantly contributed to the hospital's increase in volume over the last few years. Seizing opportunities and addressing the community's needs sustains growth How can a standalone safety-net hospital sustain financial growth? Mr. Sánchez says, "Never lose a business opportunity." Proving it Takes a Village: José R. Sánchez and Norwegian American's Remarkable Turnaround By Tamara Rosin José R. Sánchez

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