March 4, 1998

A recent newspaper article comparing MUSC Medical Center and Roper cited several statistics which are misleading. The numbers made it appear that Roper was growing at a much greater rate than MUSC. To set the record straight, we’ve compiled the following information on our performance over the last five years.

MUSC Medical Center

Occupancy 1992--79%; 1997--70%;Variance --(9%); Percentage change--(11%)

Net revenues (In millions) 1992--$286.2; 1997--$381.9; Variance--$95.7; Percentage change--33.4%

Surplus 1992--$9.8; 1997--$12; Variance--$2.2; Percentage change--22.4%

Admissions 1992--20,225; 1997--25,749; Variance--5,524; Percentage change--27.3%

Outpatient visits 1992--236,674; 1997--435,697; Variance--199,023; Percentage change--84.1%

Employees 1992--3,065; 1997--3,284; Variance--219; Percentage change--7.1% (Medical Center only)

In comparison, records indicate Roper’s occupancy was at 61 percent in 1997. They had 15,467 admissions in 1992 and 15,615 in 1997. Their outpatient visits were up 100,000 between 1992 and 1997, while MUSC’s were up by nearly 200,000 visits. Roper has about 3,100 employees.

Some areas in the Medical Center continue to have a shortage of beds, while other areas are not full. Unfortunately, this is not an easy fix—we cannot, for example, send medical/surgical patients to empty beds in the Institute of Psychiatry. We are looking at ways to reopen hospital rooms currently being used for functions other than direct patient care. Also, Charleston Memorial Hospital has submitted a certificate of need to the state for creating a long-term acute care facility. This could ease our situation by transferring patients from Medical Center beds to the new facility.

On another note, the State Health Plan (health insurance) recently announced it would be going to the state legislature to request more funding. Current payments from the plan to providers are competitive. It would not surprise me if, in the search for ways to save the plan money, the legislature asks for reductions in reimbursement. Because of the large number of people covered by the State Health Plan, this could affect (reduce) the Medical Center’s net revenues and is something to keep in mind as we focus on reducing costs.

W. Stuart Smith Interim Vice President for Clinical Operations Interim CEO, MUSC Medical Center

Affiliation Update

• Joseph C. Good Jr., general counsel for MUSC, spoke to the management team on recent events surrounding the Medical Center’s proposed affiliation with Columbia/HCA Healthcare Corporation.
• Good said he is aware that the process has been frustrating. Just as Medical Center employees were preparing to operate separately from the university, the affiliation plans came to a standstill. He also acknowledged that it is confusing to read conflicting information in the newspaper from one day to the next, and he attempted to clear up the situation in an overview of the affiliation process to date.
• Other colleges in the state have the power to sell or exchange property when needed. However, when MUSC’s Board of Trustees was formed many years ago, it was not, for some reason, given any powers regarding the sale or exchange of university property. This came to light some years back when the university wanted to sell the president’s house. At that time, and on several occasions since, the university was advised to get special legislation at the state level when it needed to sell or exchange property and this was not a problem.
• When the Medical Center began working on affiliating with another organization, the issue of the lease of MUSC property (the Medical Center) came up and on advice of the attorney general was brought to the state legislature for approval. As time was of the essence, the contents of a bill on higher education (which had been read two of the required three times at the state legislature) were replaced with legislation dealing with affiliation. The bill passed.
• A lawsuit was then filed by opponents of the affiliation. The lawsuit held that the bill was special legislation and was illegally passed. In a sense, the lawsuit helped MUSC by forcing a court decision on the constitutionality of state institutions working with private organizations. MUSC assured the State Budget and Control Board that it would not move forward with the proposed affiliation until the State Supreme Court ruled on the constitutionality of the issue. That court, however, ruled that the issue needed to be heard by the lower courts first.
• In the meantime, Columbia/HCA came under investigation by the federal government, and the MUSC Board of Trustees announced it would await the outcome of the proceedings before finalizing the proposed affiliation. While opponents of the affiliation interpreted this as an end to the deal and therefore to the lawsuit, MUSC did not, especially since a court decision on the constitutionality of any affiliation was still needed.
• Recently, the Circuit Court ruled on the lawsuit, and MUSC’s opponents were quick to claim victory. However, as Good explained, of five issues ruled on by the court, four are seen as victories for MUSC. Only one ruling, that the bill authorizing the affiliation was passed illegally and was special legislation, hurt the affiliation in that it made null the current deal. The judge ruled that the spirit and intent of the law is to have the title of legislation match its contents so that there is no doubt that lawmakers are aware of what they are voting on.
• Good said that MUSC will appeal the decision—NOT with the intent of being abrasive, but with the intent of getting a final decision from the State Supreme Court for the purposes of this affiliation or any affiliation desired in the future. He said the first priority is to get clarification from the Supreme Court on the issue of state and private organizations working together. Once that issue is decided, the MUSC Board of Trustees can then decide the best course of action for the Medical Center.

JCAHO: “Remember Me?”

• The Medical Center recently received a report from consultants on recent changes to Joint Commission on Accreditation of Healthcare Organizations standards and on how the Medical Center can best address the supplemental recommendations received during the August JCAHO survey. Our score of 97 on the survey and the resulting accreditation with commendation—while great—means the JCAHO is more likely to visit the Medical Center (unannounced) to survey certain “focus areas.” For 1998, these areas are: special procedures (restraints); medication use; environment of care (design); performance improvement (assessment); human resource planning; and competency.
• Highlights of JCAHO changes include:
• Standards scores in more than 300 areas are tightened.
• There are 52 potential new Type I recommendations (where corrections must be made in a certain time frame and to specific standards).
• Seventy-six Medical Staff standards have been tightened. q Scoring caps have been removed from three JCAHO chapters—information management, infection control and continuum of care. Now there is no limit to how badly a hospital can score in these areas.
• One new standard on patient rights affects the Medical Center and needs to be added to our code of ethics. The standard states that hospitals do not let compensation and payment interfere with clinical care decisions. (This is a sleeper standard—it speaks to compliance issues.)
• There were three changes to information management standards: q Medical record review is now required to be ongoing and should be reviewed at the point of care. The review should include a representative sample of records and should be interdisciplinary.
• The JCAHO will look at overall delinquency of medical records by the institution’s definition of delinquency. The JCAHO will no longer break out history and physical records and operative notes. A cautionary note: History and physical reports within 24 hours are still a requirement as are operative reports immediately following surgery.
• Emergency services and ambulatory care services are required to have relevant patient information readily accessible (but not necessarily the entire medical record).
• There were two changes to environment of care standards:
• One requires that fire testing be broken down in line with National Fire Prevention Association guidelines and adds a new testing requirement for stand pipes and hoses.
• The other change requires hospitals to institute temporary emergency notification systems when fire alarms are down for more than four hours within a 24-hour period in an occupied building. (In other words, the local fire department or a similar emergency response group could be notified and asked to provide a fire watch.)
• Keeping up with changes and being vigilant to maintaining existing standards will help ease preparations for the next JCAHO survey. As an example of actions taking place, infection control nurses will be doing a survey in the Medical Center to check for proper storage of hazardous materials and waste.

Announcements

• Make-up sessions on compliance issues will be held to accommodate managers who were unable to attend any of the classes scheduled in February. Directors will be receiving information packets that include the compliance policy and code of conduct. Employee training on compliance issues will need to be completed by May 1.