November 15, 1996

Pathfinder Meeting- Questions and Answers

Continuing this week in the Reporter, VUMC leadership answers questions submitted by faculty and staff following the recent meetings outlining the institution's strategic direction.

This week's questions were answered by Norman B. Urmy, executive director of Vanderbilt University Hospital, and Richard L. Smogur, director of Human Resource Services.

If for-profit hospital corporations buy up community hospitals and then hang on to the "profitable" or "easy" patients, while sending Vanderbilt only the "toughest" or "poorly insured" patients, how can our hospital stay competitive in the financial numbers game?

Urmy – This is a succinct statement of one of our toughest challenges. We are relying on our creativity, technology and expertise to find solutions. In addition, we will seek to "level the playing field" by negotiating for payments consistent with case complexity. In addition, we will seek government funding for charity care that is essential to the community. Finally, we believe that our education and research missions, which enhance our abilities as a patient care organization, will also allow us to expect some added payments or price differential which will help with our "numbers game."

During the presentation it was stated that our goal with regard to health care in the future needed to be "offer the highest quality care for the lowest possible price." When I look for the "highest quality" in a car, restaurant, or a home, I do not expect to find the "lowest price". Which are we striving to become, low price leader or highest quality? I don't think we can be both. Each requires a different strategy.

Urmy – You are right. Highest quality generally can't be provided for lowest price. Our emphasis is on quality. However, given that, we must strive to keep our prices as low as possible. We have to have our prices be affordable to purchasers of health care. It's a tough challenge with no easy answers.

What happens when the level of care given is compromised by nursing staff layoffs?

Urmy – We do not wish to compromise quality of care for any of our patients. Our efforts to reduce expenses are a direct response to those we serve and their desire for health care at a reasonable cost. We must balance cost/quality to provide best value.

Why can't there be certain grants or discounts for employees to attend classes which would help improve their job performance, or to transfer into a field that better suits a patient's need and the employee's interests?

Urmy – The university does provide tuition discounts to staff in certain situations. And the medical center will provide training on the job or pay for training outside the medical center when the person's department deems it important for that person's performance on the job. Interested staff should discuss this with their supervisor or someone in Human Resources.

How do we compare to other local hospitals regarding staff pay and benefits?

Urmy – Every year we perform a detailed analysis of where we stand compared to local hospitals. There are differences in the mix between pay and benefits, so the comparison cannot be exact. Our analysis shows that we are competitive across most jobs. Where we find ourselves too low, we make adjustments for those specific job classifications.

Are we going to tighten our doors to admissions (i.e. agreements with hospitals for back transport for limited and uninsured patients)?

Urmy – We don't expect any change in our current policy which states that satisfactory payment arrangements must be made prior to admission except when (1) it is a true emergency or (2) where the services required by the patient are available only at Vanderbilt University Hospital. We rely on our attending physicians to make the determination regarding these two exception situations. Abuse of this policy by outside physicians or hospitals is followed up.

How can you expect employees to be candid about problems when you ask for a signature?

Urmy – The signature is optional. Some people are willing to "go on record", others are not. Either is okay.

Due to "cost cutting," will benefits stay intact and not be reduced?

Urmy – There are no plans to change our benefit options. There will be some changes in the cost of some of the health plan options.

Why is West Hudson here if there are no further layoffs?

Urmy – West Hudson is here to help us learn to manage our personnel expenses. There are no layoffs planned. If staff reductions are found to be needed, attrition and transfers will be used, not layoffs.

How much has West Hudson cost? When money has been such an issue, they have done nothing we couldn't have done, but antagonize the staff.

Urmy – West Hudson is paid a fee for their work. It varies depending on the amount and scope of what we ask them to do. We monitor and manage that so that the benefit we get is greater than their fee. Also, West Hudson guarantees our savings will exceed their fees, or they pay the difference.

How many jobs has West Hudson cut?

Urmy – West Hudson isn't cutting any jobs. They are a hired consulting company working with individual hospital departments to keep our costs as low as possible. Decisions to change staffing are made by hospital supervisors and department heads.

Will hospital and VMG ever combine their billing claims? Patients pay their co-pay to VMG and then get bills for facility charges, which upsets the insureds.

Urmy – Most insurance companies pay hospitals and doctors using different systems so it is unlikely we will combine our billing systems. There are times when there are two separate charges (one physician, one hospital) for the same visit to VUMC. We can try to simplify the processing and collecting in these situations, but we will always have situations like this.

Can there be a better effort to monitor the propping open of the VUH doors by McDonald's at night. It is very expensive to heat and cool the air outside the hospital as well as security issues. I do close them when I see them but I don't work every day.

Urmy – Thank you for your diligent efforts. It would be great if all staff took responsibility as you have. I will ask security, housekeeping and plant operations to make an effort to monitor this.

I would like a central place to send changes of address for employees. It amazes me how much Vanderbilt mail still comes to the wrong address. It seems one must send a change to each department and in some cases different areas of the department. Maybe a list can be made listing addresses and departments one needs to send the change to.

Smogur – Right now the University does not have a fully integrated data base. Many organizational units work with data bases they have created for themselves in an effort to best meet their operational needs.

The lack of a fully integrated faculty and staff data base has been identified as a need at the University, and currently administrators are engaged in meeting with various vendors in an effort to identify and implement a new comprehensive and fully integrated system. Until these changes come to pass, I don't think we will be able to fix this problem or even identify the many individual departmental or sub-departmental data lists that are at the University. In order to ensure that you receive important documents such as your withholding notification and changes to the University benefits program, I would suggest that for the time being you ensure that Human Resource Services and your home department have correct information at all times. You can check with Human Resource Information Systems in the Peabody Administration Building or Employee Relations in Medical Center North to change an address that will activate the current data base.

My husband, who is a medical school faculty member received a letter at home about this meeting, as he did about the recent Celebration. I did not. Many of us in the Medical Center Development Office are paid via University payroll but work for VUMC. My observation is that because of this difference we do not receive the same level of communication. Yet, we are frequently at the front line in representing the institution.

Smogur – Right now the University does not have a fully integrated data base so it is difficult for us to be able to differentiate individuals by actual physical work location. Currently, administrators at Vanderbilt University are looking at upgrading our system and are actively engaged in conversations with vendors about purchasing and implementing a new and comprehensive system. Until that comes about, it will be difficult, if not impossible for all the different organizational units at the Medical Center who send out information to be able to ensure that all Medical Center "people" are on the list. I think at this point there is not a quick fix that will ensure 100 percent accuracy. Your suggestion is valued and does point out an area of deficiency at the University and one which we are actively trying to rectify.