Skip to contents
In This Issue:
The following are excerpts from the question-and-answer session that followed Gottlieb’s presentation. Cheryl Locke, vice president, Human Resources moderated, while Gottlieb; Andy Whittemore, MD, chief medical officer; and Arthur Mombourquette, vice president, Support Services, responded to questions from the audience.
Q: When we first completed our budgets back in May, there was a large budget gap. I know there have been teams put together to take a look at this gap and to even it out. Can you elaborate?
A: (Gottlieb) We do have a final budget that has curbed much of the gap. Through a combination of improvements in revenue, a reduction in expected growth of expenditures, as well as a slight easing in the target, we were able to produce a budget that is relatively similar to the year we just completed.
It’s not a global plan. It’s a series of individual variables that save anywhere from $200,000 to $3 million that’s being closely managed by VP-led teams throughout the hospital. We have also created measurements to determine how we are doing; therefore, we will have a good idea of where the variances are on a month-to-month basis.
Q: What do we plan to do differently next year so we don’t run into this significant budget gap again?
A: (Gottlieb) We are engaged in a multi-year strategic planning process that is ongoing and was very helpful as we developed our FY 04 budgets. But, we experienced this current gap because of state cuts in Medicaid payments and changes to the free care pool, because the federal government did not ease the ongoing cuts in its Medicare budget, and because the mix of people who have commercial insurance relative to HMOs is changing – all things we could not have predicted.What we did anticipate, but could not exactly quantify until closer to budget time, was related to the exact cost of the new rents for research and administrative space. Additionally, there were very substantial increases in the costs of health care benefits and the costs of funding our pension program.
A: (Whittemore) In closing an impressive budget gap this year, we are taking on some fairly aggressive projects regarding utilization with respect to Labora-tory, Radiology, Pharmacy, as well as length of stay. One of the greatest challenges for us is minimizing the length of stay in order to increase bed capacity for the next patient needing admission. We have set a very aggressive target and so far we’ve done a good job. We’ve hit our budget targets this past year and are on track to hit our targets for the year ahead. This is an important part of our utilization strategy.We are also coming up with several new approaches to laboratory utilization. One example is that we are migrating toward a completely film-less system in Radiology through which we can save both dollars and space, as films will now be recorded as digital images and distributed electronically. Dr. Andrew Sussman has led significant efforts to reduce clinical lab and pharmacy expenses, both of which will require changes in our practice patterns. At the same time, we still have to reinvest in our business. For example, we have budgeted $4 million over time for important barcode technology, which is something we’ve been talking about for a numbers of years.Critical technology does not come without expense. We are trying very hard to balance these expenses, and I am very optimistic.Overall, we are dealing with these things one by one to help us meet our budget gap closure strategies.
Q: Do you foresee any change in reimbursement in the Outpatient Ambulatory practices?
A: (Gottlieb) Finance has done a tremendous job providing tools to analyze each of the individual areas on the outpatient side, which we’ve never had the ability to look at before. Also, as part of our Service Excellence initiative, we’re working to improve the front-end registration process to create the ideal patient experience by reducing the complicated nature of registration onsite.
Q: Is the hospital entertaining offering any early retirement packages?
A: (Locke) No. Early retirement packages would suggest that we want people to leave, and we don’t want people to leave. We’re recruiting for the most incredible talent across the organization, and we certainly are not eager to lose that talent and experience. In fact, we are currently recruiting for about 579 positions, which is down from a couple of years ago when we were up around 900. Some of that has been the incredible recruitment staff and some of it has been the economy, but a lot of it has been because we are all working very hard to make this a great place to work.
Q: There is a rumor going around that an independent contractor is being hired to take over the Food Services Department. Is this true?
A: (Mombourquette) I have had conversations with a food service contractor, but let me provide some context. As the hospital has evolved over the last 22 years, what was once office, support and supply spaces have become high-tech, high-power consumption testing and procedure areas.Today, our kitchen sits right next to an electrical distribution center that needs to be expanded, so we are looking at creative ways to make our kitchen smaller so that we can build out our electrical capacity.Bringing in a contract management service is just one of the options we are considering.Running parallel to this option is an effort that many Food Services employees have been involved in for over a year now, which is related to the quality initiatives that Dr. Gottlieb described earlier. We are looking at providing Food Services in a very different way–—going from a mass production process to a room service process. Some of the interesting work that is coming out of our in-house department suggests that we may be able to accomplish this in a smaller amount of space.However, no decisions have yet been made. At the same time, we are paying a consultant to help us define how we can create a more efficient kitchen ourselves and provide better service for our patients on a day-to-day basis, without changing the way we manage the department currently.I would like to make a decision soon. We’ve talked about trying to get all of our information lined up before the holidays so we can put this to rest in a fairly quick fashion.
Q: It seems to be harder to keep high volume areas clean, specifically Ambulatory Care. What is Environmental Services doing about this?
A: (Mombourquette) It is getting tougher by the day. Our staffing has remained pretty consistent for a number of years, but we have done a lot of reallocation of staff from cleaning the Pike to turning over discharge beds and working in the clinical areas. We are looking at the balance all the time and trying to run a program that is fiscally responsible but also keeps the hospital as clean as possible.
A: (Locke) If there are specific things that you see or if there is a particular area that you are concerned about, please let Rick Bass and his staff know.
Q: Where are we in the process of achieving the hospital’s diversity goals, and how does BWH compare with other organizations?
A: (Gottlieb) We are working on diversity plans on a variety of different levels, in terms of the overall workforce as well as in specific leadership areas. The benchmark should not necessarily be where other hospitals are; the benchmark should be reflective of the richness we must achieve to both nurture and reflect our community and create the greatest pool of talent.
A: (Locke) One of the areas that we’ve really concentrated on over the last year or so is diversity among the Nursing staff. We originally had a seven percent goal in place, which we actually exceeded, bringing in 15.4 percent of nurses that are people of color in FY 02. We are looking at this from all levels moving forward. It’s not just a matter of recruitment; it’s also a matter of retention and development.