Adapting to the Changes in Health Care

Thank you all for your very helpful thoughts and suggestions. It was hard for me not to jump in and respond but I really believed it was important for you all to debate the relative merits of the suggestions that were put forward. As I explained previously, this is not an issue of not having a plan or even having the wrong plan, there are things that happen that are completely out of our control. Much like life, it is how you adjust to those changes that are unexpected that often define both our personal and professional success.

We will be making changes immediately to address the things we can address, contractual changes, keeping our appointments filled, redoubling our efforts on cancellations, aggressively hiring additional therapist, seeking additional long term care beds to address the kids who end up "stuck" in inpatient awaiting a bed - a whole host of things. We have all been giving our best and we need to continue that over the last five months of the year to close the $700K budget gap we find ourselves in. Senior Leadership is committed to continuing to look at every possibility to create savings, while still maintaining the quality of care and work environment that is so important to all of us.

You can see the passion in the many responses to the blog - people protecting their areas while offering up others. Many of you have written to me off line and made other suggestions. I am not going to respond individually to each of the suggestions that were made but know each suggestion was fully examined and considered. Some things we couldn’t change for safety reasons, others for equity, and others because we thought it wasn't the right thing to do for the organization.

The strategic planning process that we did in 2001 led to all of the great success we have had to date. It was a thoughtful plan of growth, balanced with getting our financial house in order. At key points we took stock of the plan, decided not to move forward on some projects and to move faster on others. The Board of Directors has charged us to build on that success and craft the vision for the next 3 to 5 years. We will present to them a strategic plan in September that will set the map for the future.

Having said that, much of the changes that will come before us will not be what is in that plan but things that are done to us by others. The bottom line is that health care is changing every day. These changes will be imposed upon us through regulatory, customer or payer demands. The key for us will be how agile we are in adapting to the changing environment. Paramount in all of our efforts is the desire to continue to provide high quality services to our children, have a good work environment for each of us to work in and that the organization remain financially viable.
I am asking you be part of solving the challenges we find ourselves with both short term and long term. We all have to be rowing our oars in the same direction. We will continue to examine the work we do - all of it. Continuing look for ways to do things better, smarter and constantly reviewing what businesses we are in and why we are in them. This is an organization of tremendous talent and heart.

We will get there - together.

Financial Update – What You Need to Know

There will be a lot of discussion from your Director's and Managers over the coming weeks about our need to find savings. Please do not take these discussions lightly. Our May financial results reported a current LOSS of $700,000 year to date.

This is not good for many reasons. First, and simply, it is never good to lose money. It is especially bad when people loaned you $57 million to build the new hospital in New Brunswick with the intent that we would make money and run our business efficiently.

The reasons for our current financial state are three fold which involve operations, inpatient and outpatient census. The first is that we have had higher costs, energy etc, that we couldn't have anticipated. Second, we were off just 1.3 days on inpatient census and that small amount reduces our revenue by almost $500,000 through May. Third, we are 13,000 “half-hour units” below where we need to be on the outpatient side and we are struggling to fill 12 open therapy positions. All of these things have left us in this predicament.

There is a light at the end of the tunnel and I’m happy to report our census has picked up on the inpatient side thanks to the great work of our admissions team and clinical staff.

We are currently examining all of our expenses and seeing if there are things we can push off until next year or do differently to receive immediate savings. I know that when we all pull together we will identify savings.

Our Foundation has graciously agreed to pay for our recognition around the NJBIZ gifts. We are so fortunate that they are always willing to step in and support us when they can.

I personally wanted to make sure that I gave you the most current information we have because I know the rumor mill has already started.

Of course your questions and suggestions are always welcome.

Congressional Update on War Supplemental Legislation

President Bush signed the War Supplemental legislation. This is the important legislation which includes the languages which continues the moratorium on the federal regulator from issuing regulations that would eliminate rehabilitation services for the majority of the children we serve.
The good news is that we bought ourselves some time, until the extension next April. The bad news is that the people who wrote this legislation will be there regardless of who is the next President. We are now going to begin a full effort to try and get to those regulators and educate them about the unique nature of what we do.

Thanks for all of you who sent emails and offered support to me as we fought this fight.

More to come.

Bring Our Story to Capitol Hill

On the road again - Last week Donna Provenzano, Dir. Family Centered Care, Child Life and Rec Therapy; Heather Valeo, Family Faculty member and Heather's five year old daughter Bella went to DC as part of a national effort by the National Association of Children's Hospitals.

The Valeo's were one of thirty families to sit with Members of Congress and their staff to tell our story. Members of congress will always see me as a "suit," a passionate suit who won't stop talking about Children's Specialized Hospital, but still a suit. It is when they can meet a family in person and hear directly from them what the services that we provide mean to their lives, there is absolutely nothing more powerful. We found that again this week.

After Heather told her story and I had gotten off my soap box about the injustice of the latest rules from the federal government that would eliminate Medicaid payments for any service where the child hadn't lost a skill but never had it in the first place, Congressman Ferguson offered his hand for Bella to shake. Being 5 she gave him a great big "squeezy" bear hug. And as long as she was up there, decided it would be a good time to play with his ears, because they were there for the taking. Being the father of 4 young children, Congressman Ferguson said he felt right at home. I guarantee you while he may have had 20 meetings that day, this is the one he will remember at the end of the day. Not my rants about CMS but Bella. And then when I go back the next time and ask for one more thing for the hospital, he will remind me of that wonderful day.

Advocacy is tough - it is not always about being right on the issues. It is about being right on the issues and touching someone's heart in the right way so they will stand up and fight for us. We are blessed with a Congressional delegation that will fight.

Part of the way we stay present, is the press stories. Please don't forget if you have great things going on with a child and you think the folks are willing, please hand those stories off to Rebecca Mazzarella. Elected officials read those stories and they help our case.

Meaningful Recognition

Our entire senior leadership team hopes you were surprised with our Best Places to Work recognition award – the choice of four CSH items. Please be sure to fill out your form and get it into Marketing before June 30. We can’t say thank you enough for helping us become the Best Place to Work in New Jersey!

The recognition I cherish are ones that only I see. One of the director's left me a note on my chair one day - "I appreciate you". One of our board members who has been involved with the organization for the better part of 40 years sent me a note to my home after our move to New Brunswick and said such kind things about how the organization has grown. There have been many times you have emailed me a thank you. I save them, cherish them and reread them when I need a boost. So for me the ones that mean the most come from the heart and are spontaneous.

How about you? Is there some recognition, or act of kindness, that has meant something to you at the work place that you would like to see more of?

What I Know Now... Life Lessons

Have you ever read of those "Oh my god books?" The one that you think the author was actually looking in your head and stole your thoughts? My latest is, "What I know now" edited by Ellyn Spragins. This short read is a compilation of letters written by very successful women to themselves. They are writing at the point in time when they were most in need of advice. So the women, give that advice, in the form of a letter “to their younger self.”

This year, I will be 43. I remember that there was a time in my life - probably the age of many of you - that I thought 43 was SO OLD! Here is what I know now - the things I thought would literally prevent me from living the life I had all planned out - the toughest things - not having children, getting divorced, losing a job.

Here's what I know now - you live through all of it. Just like the kids who end up in our care - the worst things happen, the unthinkable and whether you want it or not - the sun is going to come up tomorrow. Always. And you will be left to have the courage to figure out whatever situation you are presented with. I wonder whether at 30, would the book have talked to me in the same way - I am not sure - some things only come with age. But if the book can talk to you and help you see what a tremendously wonderful person you are and how much you have to offer, whatever is going on in your personal and work life, then it is all good.

I highly recommend this book - it shows you great insight into some of the most amazing people of our time (Cokie Roberts, Queen Noor, Beverly Sills, Pikaboo Street and more) and shows you at their darkest moment - the thing they needed to remember was that they had more than they knew, and that they needed to listen to their inner voice.

I would love to know what you think of the book.

Have you ever had a “What I Know Now” moment you’d like to share?
Maybe a family move that changed everything for you?
Or maybe a life style change that catapulted you in a new direction?

Census and Productivity… The Numbers Game

Many of you have asked - is this blog real? Yes it’s real. I’m personally writing each entry and always welcome suggestions for topics.

People also ask, “Are you just going to talk about soft issues or will you use the blog to talk about the hard stuff?” Okay - so I heard you and I took on the challenge and this post is one of the issues I know there is chatter about, not necessarily to me but chatter none the less. This post is about productivity and pressure on keeping the census in all our programs.

So, what’s with all the numbers? Why do we have a daily census report? Or monthly cash goals?
And why do we put so much emphasis on patient productivity in our outpatient sites?

First and foremost know that Senior Leadership knows how hard you all work. Whether it is treating kids or scheduling appointments, we are all giving our best. We also know that if you don’t measure what is meaningful, you have no way to know whether you are being successful or not.

The easiest answer for why we measure things like efficiency and collections is in some cases these numbers generate bills, which generates cash, which is how we pay our employees and all of our bills. Just like in your budget at home, your salary covers most of your bills and provide you with the recourses to do your job. There may be some flux with a check from a family member for a holiday, but 99% of the dollars come from your salary. When we treat a child in any of our settings, billing for that service is what pays our bills. When kids aren’t admitted, or don’t get treated, or cancellations occur - we don’t get paid and then we can’t pay our bills.

Every year we set a budget for each department based upon our mission and strategic plan, as well as your requests for new programs, equipment, and how we expect to be paid for each of our services. We also examine how many children are on the waiting lists to be served. We take that budget number and then determine how many children we would have to treat in all of our areas: inpatient, outpatient, EIP, the school, medical day care and long term care. For the last few years, we have had to hire more staff to be able to meet those numbers,

There have been lots of questions about productivity - how is it calculated?

On the inpatient side, we are budgeted for an average daily census of 50 and children should receive on average, three hours of therapy a day. In long term care we need to have a total of 64 children being treated in both sites and in medical day care 25 children need to be treated every day. In EIP we have made a change recently to our hours based upon the changes in the market places. On the outpatient side, we ask staff to treat children 24 hours a week if they work a 40 hour week. That leaves 16 hours for meetings, cancellations, paper work etc.

We anticipate for TOP time, conference time when we calculate these expectations. When we fall below those budgeted numbers, simply put, we can't pay our bills.

Now we all know that kids get sick, there are holidays' there are cancellations and it makes it hard some weeks to make the numbers. But overall, those are the numbers we have to make. When we don’t make those numbers, we fall behind and can’t pay our bills.

I know this isn't the fun stuff. This isn't the warm and fuzzy stuff that makes you feel good about getting up and coming to work. I know these questions are out there and wanted to address them head on to help clear up the gray areas.

Let’s hear it: Do you have any questions/comments about patient census or productivity?