OCEAN CITY – The Mayor and Council heard an update from Atlantic General Hospital (AGH) this week on current finances and strategic initiatives aimed at keeping the health system ahead of the industry curve.
In fiscal year 2012, AGH’s revenue topped $87.5 million with a cost of about $87 million to render services. The hospital did receive a little over $1 million in non-operating revenue, such as generous philanthropic and endowment support from the community, resulting in net revenue of about $1.5 million.
“We are continuing to have an income from our operations and also continue to have a generous community that is providing philanthropic funds to our campus, which allows us to continue to capitalize and continue to grow the services for our community,” said AGH President and CEO Michael Franklin.
Over the last few years, the State of Maryland has imposed challenges among hospitals beginning with financial assessments to help offset the deficit caused by an increase in Medicaid enrollment, meaning AGH had to pay millions of dollars to the state that previously it did not.
“That has put a lot of pressure on the operating margins not only at AGH but all hospitals,” he said. “If you look at our comparison year over year, you can see that based upon having a really busy summer … and also having a growing community we have billed out a significant amount more than we did in the previous year but due to the increase in the state assessments we had over a $1.3 million increase to the state assessments, which continues to put pressure on our margin and to re-capitalize to keep things going but again that is being offset well by the generosity of the community.”
A regulatory challenge being met at AGH is the change in observation status. The Observation Unit has been established with the elimination of one-day stays. It allows attending physician time to perform diagnostic tests to determine need for admission vs. discharge. Reimbursement for care is less than the admitted patient, Medicare patients are responsible for cost of self-administered medications during their stay and does not count toward Medicare three-day stay for coverage or rehabilitation services.
“This particular change in how healthcare is being delivered and structured is also affected,” Franklin said. “When you look at our statistics, it appears as though our admissions have gone down, when in fact our total patient experiences … have significantly increased from one year over the next.”
AGH’s newest strategic plan was put into place last year and will play out through 2015. An initiative within the plan during 2012 was to improve the Center for Joint Surgery. The hospital hired a clinical director and adopted a strategic plan to improve patient navigation and track satisfaction/outcome data.
In addition, the triage space for the Emergency Department was improved, converting two registration rooms to triage rooms and the existing triage room to a protocol room as well as added a pneumatic tube system for laboratory tests. This has resulted in 90 percent of visits in 2012 meeting AGH’s “30 Minute ER Promise”.
Other facility improvements in the last year include the east entry being redesigned with improved access to entrance and improved patient and visitor safety. Patient rooms have been renovated with aesthetic updates, installation of care.connection units and fixture reconfiguration to improve patient safety and comfort.
Through Care.connection, personal flat-screen units were installed in each patient room last October in conjunction with the room designs. Franklin described the unit as a large iPad that serves as a T.V., Internet connection and phone, among other things, for the patient.
Also, the main lobby was renovated moving the placement of the front desk closer to the entrance and updating lighting and furnishing. The cafeteria was also renovated with increased square footage for additional seating, including outdoor seating and accommodates dietary requirements and wishes, along with an improvement in café service.
AGH has also been focused on the plan of Patient-Centered Medical Home (PCMH) that was adopted in 2009. In July of 2012, AGH was one out of three organizations in the State of Maryland to receive a $1.1 million federal grant from the Centers for Medicare & Medicaid Services (CMS) to expand PCMH to Health System Primary Care Physician (PCP) offices for Medicare patients. AGH has achieved National Committee for Quality Assurance (NCQA) Level 2 Recognition for Berlin Primary Care and Townsend Medical Center locations last October.
“This is allowing us to build the infrastructure that is necessary for our physician practices to adopt a new design of patient care … that the shortage of physicians can accommodate a growing population and how we can do a better job in making people healthier in the community preventing hospital visits,” Franklin said.
The hospital’s “eStrategy” continues with the electronic medical record system called PERKS. The system is going live in the hospital this Monday and will eventually connect patient’s records in all hospital departments and AGHS locations. AGH physician offices and the emergency room has already been activated.
PERKS has achieved CMS Stage 1 Meaningful Use for physicians in the AGH Health System last summer and for the hospital itself last October. This resulted in over $2 million in incentives that can be re-invested in technology initiatives.
In the State of Maryland, there is a list of 66 Potentially Preventable Conditions (PPC). Within the Maryland Hospital Acquired Conditions (MHAC) scaling for 2013, the state increased rates for AGH due to low incidence of PPCs among inpatients during FY12, resulting in almost $438,500 in additional revenue. AGH had the lowest percentage of PPCs of all hospitals in the state.
Looking ahead, Franklin said AGH will be focusing on expanding services in the southern Delaware market, being the closest hospital to that area, as well as working on vascular access and care and improve wide area network connectivity throughout the community.
“The reason we are doing this is because it is our role in this community to make sure we are doing the best job possible to care for everyone in this community and advance the health of the residents and visitors,” Franklin said.