Roy Exum: Erlanger’s Early To-Do List

Wednesday, March 27, 2013 - by Roy Exum
Roy Exum
Roy Exum

Exactly one week before a stranger to us –  Kevin Spiegel – will assume one of the most daunting tasks of his life, the Erlanger Hospital Board of Trustees was told on Monday night that our hospital and its Level 1 Trauma Center, had lost another $2.5 million in the month of February. Among the dour reasons given was that not enough patients arrived by helicopter. My gracious, when we have to rely on gouging insured trauma patients with an obscene helicopter bill, the Apocalypse is nigh.

Spiegel, who will assume the CEO’s chair early Monday morning, has a huge stack of problems begging for his attention. Because of vapid leadership on both the executive and board levels, Erlanger’s continuing hemorrhage of cash now threatens the hospital’s bond covenants and, when an effort by the area legislative delegation was quashed by the County Commission, it assured his walk will be lonely in the beginning.

From every quarter come cries to trim the “deadwood”  from the board, most pointedly at current chairman Ron Loving, and, while it will now take months to redraft a governance solution and every bit as long to request and acquire a streamlined 501c3 operating structure, current board members need to be empowered to help.

If the legislators group does not address county commissioners’  issues before the end of the session (mid-April) the presumption is that County Mayor Jim Coppinger will fill two vacancies on the Erlanger Board next month to give it added strength before a modified bill will be introduced next year.

In the meanwhile, here are a half-dozen places where I would put the first oil if Spiegel’s problems were mine:

ONE -- We have to change the whole mindset of the place, the whole culture. If Emory and Vanderbilt can promise that no patient will ever wait longer than 30 minutes in a doctor’s office, so must Erlanger. Doctors are the first to forget that any patient who has insurance also has “a choice.” Erlanger must learn to compete instead of whine when good doctors resign but, far more, when patients do the same thing. Erlanger’s house staff will learn “The Golden Rule” or the Baroness will continue to order buckets of red ink.

TWO -- In order to keep patients, they must be offered competent physicians. While Erlanger’s Emergency Room is one of the best in all of America in my opinion, you have a wide disparity once you are admitted as a patient. So recruiting and retaining superstars is vital. My personal experience has proven that such specialties as general surgery, plastic surgery, infectious disease and urology are phenomenal but – today – the same cannot be said for orthopedics, cardiovascular care or several “bare-shelf” specialties at Erlanger. That’s economic suicide! And you really wonder why elective surgeries are down? Spiegel needs to find out whatever became of the Miller Eye Center, for example, because such a pattern repeats itself.

THREE -- The University of Tennessee Medical College is the best thing to ever happen to Erlanger, period. But now its leadership and core are beyond shaky and that’s no secret. UT must be a good partner and fix that. Good men such as Mack Worthington need help to channel promising medical students into our community after they are trained. For example, one of the best internists I have ever known has just been lured away from Erlanger to Memorial. The reason? She was tired of being bullied. Bullied! Laugh if you will, but there is a string of evidence to prove otherwise, this to such an extent some Memorial physicians call Erlanger “Memorial’s farm league.”

FOUR -- Erlanger must quickly employ a government liaison, someone who realizes these are critical times. A friend notes, “Erlanger is slated to lose approximately $21 million in Disproportionate Share payments as the Affordable Care Act is rolled into effect.” Further, I am told by my source, “Like it or not, the Affordable Care Act (or “ObamaCare”) garnered the support of state hospital associations because they made a deal:  the Federal Government dramatically cuts Disproportionate Share (DSH) payments while at the same time expanding Medicaid eligibility to 138 percent of poverty level.  

“Last year,” I am told, “the Supreme Court eliminated the provision within the ACA which would have made the expansion of Medicaid (or Tenncare) mandatory for all states.  If Governor Haslam decides against Tenncare expansion, all rural and urban county hospitals (like Erlanger) will take a major financial hit and many may not survive it.” (Good grief!)

FIVE -- Capital improvements have been ignored for the last 10 years and now it really shows. A $25 million surgical upgrade is being ramped up but, if regional hospitals in Knoxville, Atlanta, Birmingham and Nashville can provide “a better experience,” what’s a two-hour drive in any direction if the cost is the same? You can’t compete without a clean, well-lit, pleasant facility and, while nurses and floor staff are highly regarded, the dour faces at the Outpatient Services desk and sloppy house-keeping are well-known and that is lethal. The cafeteria – where patients’ families go – is the place to start.

SIX --  Erlanger’s rank-and-file (I’m talking about nurses, techs, floor staff and those in the most contact with every patient) have been ignored, the same as mistreated. In order for people to wear happy faces, they must be – hello? – happy. The hope is that Spiegel will surround himself with capable lieutenants who will make needed changes sooner than later. How does a guy making $780,000 look at a scrub nurse who is stumbling away from 12 hours on her feet? Leadership needs to remember wars are won by the soldiers, not the generals.

Oh, my goodness … the real list is endless. Children’s Hospital must be strengthened and why Erlanger doesn’t raise millions with the community from private donors and philanthropic organizations is mystifying. Public relations has waned with 18 straight months of negativity and enthusiastic faces, which Spiegel has promised he’ll provide, will be a big part of the transformation.

I just wish it didn’t kick off on April Fool’s Day.

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