October 20, 2012

CVPH changes patient-care procedures to offset deficit

Move aimed to offset deficit


---- — PLATTSBURGH — CVPH Medical Center will be changing the way it conducts daily operations to help offset financial burdens caused by a changing health-care system.

The first step in that direction, which the administration introduced to staff Thursday, will revise the nurse-to-patient and nurse’s aide-to-patient model of care at CVPH.

The new procedures are directly related to changes in health care that are impacting the hospital’s operating costs.


The Medical Center’s cost for providing care in 2012 exceeded reimbursements by $3.2 million. That deficit has been partially offset by a federal reimbursement tied into the hospital’s switch to electronic records, but CVPH still saw a loss of $570,000 from operations in September.

“We’re looking at a changing business model,” CVPH President and Chief Executive Officer Stephens Mundy said as he met this week with the Press-Republican Editorial Board.

The $3.2 million operating loss came on quickly and is a product of several factors that created a “perfect storm,” he said, including physicians linked to the hospital breaking off into private practice, a federal penalty that reduces the hospital’s reimbursement amount and changes in local and national health care that result in fewer patients.


The Adirondack Medical Home initiative, which is designed to provide more comprehensive continuity of care for patients as they move from hospital to home following discharge, is developing services that mean fewer people need to be admitted to CVPH, Mundy said.

For instance, pediatric admissions to the hospital’s Emergency Department are down 18 percent because patients are triaged through an automatic answering service when parents call a local pediatrician’s office, eliminating cases that do not really need emergency care.


Also, the Medical Center is seeing a decrease in patient re-admissions following discharge because of two major factors.

First, CVPH has initiated a patient call-back program where case managers from the hospital stay in contact with recently discharged patients, ensuring they continue receiving appropriate care while at home.

That has reduced re-admissions, Mundy said.

So has the HCR takeover of over Clinton County’s home-health-care program from the Health Department in April of this year.

“They are doing a staggeringly good job,” Mundy said of the HCR nurses who see patients in their homes on a regular basis.

Re-admissions for patients seeing home-health nurses have dropped from 43 percent to 23 percent since the change was made, Stephens noted. The state average is 30 percent for patients receiving home care.

“Every one of those re-admissions, we got paid for,” Mundy said. “We now have fewer people coming through the door.”


Ironically, as those rates improve, the hospital faces a $400,000 to $500,000 penalty on reimbursements from the federal government because of elevated re-admission rates over the past three to four years, Mundy noted.

“That penalty over time should improve (if re-admissions continue to remain low),” he said. “But we’re facing a deficit (this year) and need to look at making changes.”

That is what has led the hospital to increase the number of patients assigned to each nurse while also decreasing the number of patients that each nurse’s aide works with.


The ratio in the hospital’s Cardiac Care Unit (R-3) has been three patients to every one registered nurse. There are 10 to 12 patients handled by each nurse’s aide, meaning that each aide is shared by up to four nurses.

Under the new model of care, each registered nurse and each aide on R-3 will be responsible for four patients.

On other patient floors, the nurse-to-patient ration will remain at five patients for each registered nurse. But the ratio of aides or clinical assistants will drop from 12 patients per aide to five.

Clinical assistants will provide an added boost, as they will be able to perform other procedures, such as blood draws and EKG readings, now being done by nurses.


Mundy said he does not anticipate any cuts in nursing positions with the shift in ratios. The hospital utilizes a nursing pool that helps “float” nurses to areas needed on a daily basis, so all nurses currently on assigned patient floors will be offered positions in the nursing pool.

The changes will help reduce overtime pay and the need to use traveling nurses to fill daily needs and is expected to save the hospital between $400,000 and $600,000 in salaries, Mundy said.

“I absolutely believe this is going to be a wonderful advantage for patients,” said Bobbi Jo Otis, a registered nurse who has worked on R-5 for 10 years. “There will be so much better communication between the nurses and the clinical assistants.”

“It will help improve patient satisfaction because we will be able to have more bedside time with our patients,” added eight-year veteran registered nurse Jesalyn Hayes.

“You’re going to see fewer patient falls, less length of stay for patients,” Otis said. “It’s also going to improve our communication with the physicians.”

But at a union meeting Thursday to tell members about the changes, concern was expressed about nurses who now specialize in certain types of patient care having to float to unfamiliar units, about loss of overtime and premium pay and about lifestyle changes necessitated by having to work different shifts.


Staff will now begin training sessions to prepare for the switch, which is scheduled for Nov. 15 on R-3 and R-5 and Dec. 15 for R-6 and R-7.

“We will have very specific classes to identify job expectations,” said Brenda Murphy, director of R-5.

Staff, management and union members have been working together over several months to come up with the changes, hospital officials said.

“This was not a top-down approach,” said Carrie Howard-Canning, associate vice president of patient care operations. “It was staff driven and involved staff input.”

Email Jeff Meyers: