June 25, 1998

At our June 23 communications meeting, Howard Evert, M.D., president of Carolina Family Care, Ansel McFaddin, M.D., Carolina Family Care physician, and Melissa Altman, Carolina Family Care network director, spoke to the management team concerning the relation of the primary care network to MUSC, referrals from the referring physician perspective and hospital access issues. Their presentation was in keeping with the customer service theme of recent communications meetings and highlights are outlined below.

During his presentation, Dr. Evert mentioned the old “brown form” required for referrals in the early 1990s. In the yesteryears, a community-based physician had to complete the brown form in order to make a referral. This was the initial step of the cumbersome referral process. Dr. Evert’s point was that things have changed dramatically from the past and we must be continually attuned to access issues to eliminate the “brown form” mentality. In today’s competitive healthcare arena, we must adhere to the community physicians’ referral standards through breaking down all barriers to easy access for patients.

While much improvement has been made, Carolina Family Care physicians continue to encounter problems with certain departments in making referrals. Dr. McFaddin and Ms. Altman gave concrete examples of departments that do exceptional jobs in meeting appointment needs, and they discussed specific problems encountered recently with attempts to make timely referrals. They explained that Carolina Family Care does not have the luxury of time to waste in making referrals of patients to departments that are not responsive or helpful.

Dr. Evert emphasized while MUSC has been widely recognized in the past as a specialty care center, we must also seek to be recognized as a leader in primary care to be fully successful.

Our recent satisfaction surveys have indicated continuous improvement and we have compared favorably in satisfaction ratings with other academic health centers. But there is much work to be done as we seek to support Carolina Family Care physicians and completely eliminate the “brown form” mentality. I ask that everyone focus on how to resolve troublesome access barriers faced by patients and referring physicians. This will continue to be a priority as we move forward.

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

Announcements

Human Resources Changes

• Susan Carullo, manager of Employment, Compensation and Employee Relations for the Medical Center Department of Human Resources, announced a few minor procedural changes to the hiring process at the Medical Center. Carullo said these changes will ensure compliance with the 1996 Conciliation Agreement between the U.S. Department of Labor’s Office of Federal Contract Compliance Programs and MUSC. They also keep the Medical Center’s process consistent with that of the University.
• MUSC is held to high hiring standards by regulatory organizations because of its status as a major employer. The hiring process used must be 100 percent fair and nondiscriminatory, in accordance with the employment policy, and well documented.
• The changes include the following:
• Human Resources will rely upon the “preferred qualifications” in the job description to screen applications for certain types of positions, as opposed to using only the state’s “minimum qualifications.” This should help get managers a higher percentage of applicants that will best fit the openings.
• A review form previously needed only for those interviewed will need to be completed for every application a manager reviews as well as for every person the manager interviews. This will help Human Resources document and justify every hiring decision.
• The respective hiring official (such as the department head or manager) is responsible for the hiring decision. The Office of Diversity is responsible for reviewing faculty position hiring decisions. The Department of Human Resources Management is responsible for reviewing non-faculty hiring decisions to ensure for adherence to policy and proper documentation. Carolina Family Care: They like us, they really like us, but . . .
• In 1994, University Medical Associates formed a network of community-based, primary care physicians (internists, family practitioners, obstetrician/gynecologists and pediatricians). The network offered UMA and MUSC Medical Center a referral base among area primary care physicians. In 1995, the UMA Primary Care Network incorporated and became a wholly-owned, for-profit subsidiary of UMA. As Carolina Family Care, the network has the autonomy it needs for things like contracting and advertising, yet is still linked to UMA and MUSC.
• At the June 23 communications meeting, Howard Evert, M.D., president of Carolina Family Care, updated the management team on the strengths and weaknesses of the working relationship between the network and MUSC. He also discussed how working well with the Charleston physician community and improving service is important to the success of our entire clinical enterprise. MUSC must to be able to compete in this marketplace.
• Evert said Carolina Family Care exists to support the specialists and hospitals of MUSC. While network physicians can refer patients to any specialist or hospital, they try to send as many patients as possible to MUSC. In 1996, network physicians generated 8,000 referrals. Just over 4,000 of those were to MUSC physicians or facilities. The projected number of referrals for 1998 is 17,000, with almost 10,000, or about 60 percent, going to MUSC. The value of that number of referrals amounts to as much as $10 million in charges a year.
• Evert said MUSC has good reason to seek referrals from Carolina Family Care. The payer mix of its patients is very good, with a high percentage commercially insured. Also, the network is becoming busier every year, and can potentially bring a lot of business to the Medical Center. However, there are several reasons why not all referrals from network physicians are made to MUSC. Physician and patient preference are two reasons. Ease of access is another.
• In the past, primary care physicians were required to complete a “brown form” on patients they wanted to refer to a specialist at MUSC. The specialist would then use the information on the form to decide whether he would take the patient. Making appointments was tricky, as this was handled almost exclusively by the individual secretaries of each physician, and the number of clinic slots was limited. It was common to wait two to three months for an appointment if one could be had at all.
• Today’s community-based physicians have a new set of expectations, Evert said. They expect specialists to welcome referrals and to make arranging that referral simple and efficient. They expect that their patients will be able to get an appointment immediately if needed, or within two weeks for a routine case. They also expect to get feedback (such as a report on any procedures done or a summary of treatment required) within seven working days of their patients’ appointments. Evert stressed that the competition can deliver this and MUSC must be able to as well. q MUSC has responded by improving service, but still has room for improvement in several areas. Ansel McFaddin III, M.D., a Carolina Family Care internist, spoke to the management team on his personal experiences, both bad and good, with MUSC.
• McFaddin said some areas are very easy to work with. He mentioned the Cardiology Department, Storm Eye Institute and the Digestive Disease Center, saying that whenever he has called, the people answering the phone have been able to help him promptly. Patients he has referred there have been very pleased with the service.
• Other areas have been problematic. The wait for appointments is sometimes unacceptably long, or there have been too many hoops he must jump through to get to the person he needs. In those cases, McFaddin said he will instead take “the path of least resistance” and refer outside the MUSC system to a doctor who will give his patients the service they deserve and demand.
• Evert also discussed hospital admissions, explaining that because the patients Carolina Family Care is trying to admit are not already receiving care on campus, they have different needs. Carolina Family Care doctors need to know if a bed is available or if one will be within a certain time frame. They cannot be expected to tell the patient sitting in their waiting room that the hospital will “get back to them” about an admission. Instead, the doctors will simply look elsewhere.
• In summary, Evert said he feels MUSC has by far the best hospital in the Charleston area, and Carolina Family Care physicians choose to be affiliated with MUSC for that reason. The continuing challenge for MUSC will be to find ways to offer the kind of service customers—whether they are patients or other doctors—demand. Carolina Family Care faces the same challenges in their quest to become the primary care brand of choice in the Charleston area. The network has launched an extensive performance improvement program to work on areas where its service to patients and to payers can be improved.