Accountable Care Organization

When the Affordable Care Act was passed in 2010, ECRH decided to get into the one-sided model of an accountable care organization (ACO). This venture has not gone well, and ECRH has decided to leave the ACO business. However, they are concerned about the public image of this decision. The details of the termination are under discussion with a need to determine how to minimize the public perception of termination, particularly since there was so much marketing of their getting in this venture. The regulatory requirements of the government regarding the timing of terminating an ACO venture further complicate this decision.

Primary Care Medical Home

The employed primary care group has been active in establishing accredited primary care medical homes within all of the primary care offices throughout the ECRH system. This initiative is a positive emerging strategy for ECRH. It has also been an attractive draw for the family practitioners from Greenbranch Medical Center residency program since Greenbranch has established an accredited medical home for their family practice residency program.

American Nursing Credential Center Status (ANCC)

ECRH has been working on becoming a magnet status for ERMC. This work has stalled out as an initiative. Some of this is due to the nursing leadership within ERMC. The CEO intends to move this priority up in the organization’s goals.

Information Technology

ECRH has invested heavily in their information technology infrastructure. This investment became a requirement just to be able to gather the data needed for the ACO development. This cost has become significantly greater than anticipated. ECRH fully implemented EPIC as their core information technology system. There have been implementation problems since the ECRH was operating off of multiple systems before the decision to consolidate to one platform. The implementation of EPIC required considerable retraining for the staff and physicians. Data conversions have gone well. The difficulties have been more human-related relative to the effective use of the system. One of the major issues has been the lack of ECRH not meeting meaningful use requirements which has cost ECRH significant lost revenue from not meeting these goals.

Legal Actions Pending for ECRH

Federal Trade Commission Investigation

With the merger and acquisition of NMHC, questions of antitrust have been raised. In the service lines of cardiology and oncology it has been found that ECRH controls 60% of the cardiology market and 52% of the oncology market. Chestnut Care in some markets has been strong in steering patient volumes to ERMC. Union leaders for the varying trades were instrumental in precipitating this investigation. At the time that this issue was raised, the President and Executive Branch of the federal government were very pro-labor, thus, their interest in pursuing this matter.

As to the projected disposition of this case, it is anticipated that a negative determination will be made due to the market share control in oncology and cardiology. This could force ECRH to divest their ownership in the Chestnut Care insurance venture. Another option might be that certain hospitals of NMHC be divested. It is not anticipated that both determinations would occur. This case has cost ECRH considerable money to stave off investigation of this allegation.

Predatory Collections and the Loss of Not-for-profit Tax Status for NMHC

NMHC negotiated that they would continue to act independently. The consortium leadership set policies that included predatory collections for the patients that would be served in the NMHC hospitals. In a recent evening news report, an investigative reporter interviewed an elderly patient that had her home taken from her to pay for her medical bills. This home had been in her family for over 100 years. This story prompted the state’s Attorney General’s Office to investigate the predatory collection policies of ECRH and NMHC.

The state has already taken an aggressive stance to investigate the status of not-for-profits not fulfilling requirements (e.g., charity care, research, and education). The state is in economic trouble and is seeking revenue from wherever they can find it. The outlook is dim regarding the anticipated final decision of the Attorney General’s Office. If NMHC is required to pay taxes, this would wipe out the bottom line for these hospitals and many of the needed services supplied to the indigent population by ECRH would be reduced or eliminated.

Faith & Main Consultants Report

Within the last year, ECRH contracted with Faith & Main to study the market perception of their women’s services. The following is a summation of the findings of Faith & Main.

Interest in a Women’s Center Crosses County Lines

· 36% of women in the service area would travel across county lines to receive excellent women’s health services

· 72% of women in Chestnut County would consider using the women’s services of East Chestnut Regional Medical Center

· Women in all counties were most interested in these services:

· Breast care

· General gynecology services

· Female doctors

· Services in one area

· Physicals for women

Interest in a Heart Care and a Health Information Line

· A physician approved source of information

· A nurse help line that could be a resource for women’s care in heart health as well be a source for health navigation.

Clear Expectations Regarding Getting Appointments with Their Primary Care Physician

· Women expect same-day appointments

· In the collar counties to Chestnut County, women ranked this in the top 28.7%

· Chestnut County women ranked this in the top 37.7%

· Expectation of same-day appointments ranked highest for women of childbearing age

· Percent expecting same-day appointments

· 42.9 % of Chestnut County women of childbearing age

· 31.3% of collar county women of childbearing age

· Willingness to be Seen by a Nurse Practitioner Overwhelmingly “Yes”

· 75.7% of Chestnut County women of childbearing age

· 76.1% of collar county women of childbearing age