Americans spend more on healthcare than any other developed nation in the world, even as costs for individuals, businesses and healthcare facilities continue to rise at an alarming rate.
The Patient Protection and Affordable Care Act of 2010 has increased regulation without any corresponding increases in funding available to hospitals, and further government involvement continues to be debated. Meanwhile, amid the economic turmoil of the past few years, states are cutting programs and insurers are cutting payments. The healthcare industry has never before faced such furor and upheaval.
But, in a first-floor office at Presbyterian Hospital on Hawthorne Lane, President and CEO Mark Billings has a calming air as he answers questions about the future of his organization, the second largest healthcare provider in the Charlotte metropolitan area.
An Elkin, N.C.-native, son of a truck driver, Billings retired from a 20-year career in the Navy as a lieutenant commander in 2004. His blue-collar origins and strong work ethic that led to advancement through the ranks of the Navy, combined with military-style calm-in-the-line-of-fire training, also prepared him uniquely to lead Presbyterian Hospital through the largest healthcare crisis the nation has ever faced.
So, how is he addressing the future of healthcare and his organization? Simple, he says: “If all of our activities center on the patient, the rest will take care of itself.”
It sounds simplistic, but it’s a strategic and long-term policy that has served the organization well for over a century. In 2004, Billings’ predecessor Carl Armato formalized the tradition with a campaign to develop Presbyterian into a national leader in patient-centered care, starting with a focus on physicians. He was quoted as saying, “By staying connected with our physicians, we hear loud and clear what the patients want, and what the patients need.”
From turn-down service every evening, to room-service dining when the patients want it, Armato’s focus set the stage for Billings to take over in 2008, when Armato moved into the role of COO for parent company Novant Health.
Billings has continued the practice of focusing on physicians in order to serve the patients better. He says that every decision, at every level of the organization, includes physicians in the decision making. Further, the organization’s strategic counsel consists of physicians tapped to guide fundamental operations and strategic decisions for the organization.
Not only are physicians and patients a central focus, every staff member, every visitor, every nurse, and every patient has a voice. From hosts who greet visitors in the lobby and escort them to their destination, to helpers who assist every discharged patient to their vehicle and ensure they have a safe transition to the next stage of care, Presbyterian Healthcare relies on an enormous staff to maintain its patient focus, and every one of the staff is treated with integrity and given a voice in the organization.
Doing the Right Thing
For Billings, the attention to front-line staff is easy because he has, quite literally, been on the front lines himself. Born to a working family, Billings left high school and enlisted directly in the Navy as a sailor. During his 20 years in the force, he earned a bachelor’s degree, a commission, the rank of lieutenant commander, several medals, and a master’s in healthcare administration.
The year of his retirement, 2004, Billings signed on with Novant Health. Much like his military career, he moved quickly through the ranks, taking the reins as president of Presbyterian Hospital in Matthews in 2005, then expanding into growth and development officer for Presbyterian Healthcare. In 2008, he took over as president of Presbyterian Hospital in Charlotte and CEO for Presbyterian Healthcare, which includes Presbyterian Hospital, Presbyterian Orthopaedic Hospital, Presbyterian Hospital Huntersville, and Presbyterian Hospital Matthews.
He says his humble beginnings help him identify with the front-line employees at Presbyterian. “People often joke that if I go to the cafeterias for lunch I spend the first 20 minutes talking to people and my food gets cold by the time I sit down,” he says. “I connect with those folks. Until last year, my father was an on-the-road truck driver. The only time he stepped foot on a college campus is when I graduated and when my sister graduated.”
Billings has continued the culture and many of the initiatives cultivated by Armato, but he has also brought his own flavor and initiatives into the mix. For instance, while the Hippocratic Oath’s first promise, “Do no harm,” has always been a foundational principle at Presbyterian, Billings has brought it to a new level with safety practices borrowed from the airline industry.
“If you look at the airline industry,” Billings explains, “they handle thousands of planes a day. If even one of those goes down in a day, that’s unacceptable. They have to have tremendous attention to detail.”
On the other hand, people are harmed in hospitals every day. Consider, for instance, what a surgeon sees right before beginning a procedure—often, it’s just a small patch of prepped skin. It is absolutely imperative that the processes leading up to that moment ensure it is always exactly the right patient, exactly the right location, and exactly the right procedure.
“We have to do a better job to make sure we do the right thing for the right patient at the right time every time,” Billings says. Presbyterian Healthcare has always had a good safety rating, but since they brought in principles from the airline industry, their safety record has become one of the best in the country.
Even as Presbyterian continues to improve on their standards-setting patient care and safety ratings, the economy continues to be sluggish and healthcare debates continue to rage. Baby boomers are entering retirement and needing more medical attention, Medicaid and Medicare reimbursements are declining, and state incentives are in many cases disappearing. In such an environment, it would be easy to believe that healthcare quality would, by necessity, decline.
But Billings not only believes it’s possible to continue to offer the highest possible level of care to all comers—Medicare, Medicaid, private, and charity cases alike—he believes it’s necessary and that his organization can do it.
“We have to take a look at our cost structure and break-even rates, and we’re going to have to gain some efficiencies,” he admits. “But with some very deliberate, intentional business modeling, we think there are millions of dollars that we can be taken out of our cost without changing our care delivery.”
To show how they are going to do that, Billings chooses the example of an appendectomy. The cost to the organization to perform the procedure in Matthews is $1,200, versus $1,000 in Thomasville. There is no difference in the level of care provided, only the cost to the hospital based on specific equipment, supplies and practices involved.
By discovering the best practices employed in Thomasville and applying them across the board at all 13 Presbyterian-affiliated hospitals, the organization can provide the same level of care at a savings of $200 per procedure. Apply the same process to every single diagnosis, and the organization can deliver the same care at an efficiency that yields millions of dollars per year.
Billings is confident Presbyterian will thrive in the new healthcare economy, whatever it may be, and he has good news for business owners: Presbyterian can help you brave and conquer rising healthcare costs, too.
“I would encourage every business owner in our community to have our network development folks come to their site,” he says. “It doesn’t cost anything and it helps employees get linked in to a healthier lifestyle and better healthcare options.”
Presbyterian’s Corporate Health program offers a range of employee wellness services including onsite screenings and health risk assessments, onsite health clinics, lifestyle modification programs, stress management and weight loss, and occupational medicine services. A network development representative can help a company and its employees access the services they need to stay healthy and minimize healthcare costs.
After more than a century of serving the Charlotte community’s health needs, Presbyterian Healthcare is not about to rest on its laurels. Presbyterian Cancer Center opened a 100,000-square-foot, four-story vertical expansion this spring, including a safety/emergency management office, 5,000 square feet of educational classroom space, 90 new patient rooms, and a 20-bed cardiac triage unit.
Later this year, Presbyterian Hospital Huntersville will undergo an expansion to add 15 beds, and next year Presbyterian Hospital Matthews will add 20 beds. The system is awaiting approval from the South Carolina Department of Health and Environmental Control, but expects to be adding a new facility in Fort Mill soon also.
But don’t think that expansion will change the organization’s commitment to patient care. In fact, of the six dimensions of Presbyterian Healthcare’s 2015 Strategic Plan, three refer specifically to patient experience. First, every patient will be greeted, escorted as necessary, and made to feel at home in the hospital. At each entry point, a greeter meets patients and visitors. No one is left to navigate the halls alone.
The second two dimensions are “voice” and “choice.” They mean that patients have the right to choose the medical care that is right for them, to get second opinions, and to request care at a facility convenient to themselves or from a different care provider.
The fourth dimension of the plan revolves around patient outcomes, starting with how the organization reports on them. All hospitals are required to report outcomes to the government, but Presbyterian Healthcare goes a step further and reports the data on their website.
“In some areas, we absolutely lead the country,” says Billings. “Our orthopaedic hospital has been the top orthopaedic hospital every month for years now for surgical infection rate. Over 80 percent of our publicly reported measures are in the 90th percentile.”
The fifth dimension centers on patient safety, including patient education. The “Ask Me Three” program ensures that every patient has three key questions answered at regular bedside shift reports: “What’s going on with me?” “What do I need to do?” and “How will this impact me?”
Finally, the last dimension relates to affordability. In addition to measures already cited for streamlining and standardizing cost paradigms, Presbyterian Healthcare maintains an absolute commitment to providing care regardless of ability to pay. The hospital focuses on identifying patients who may qualify for Medicaid and other government programs, and helping them get enrolled.
Regardless of insurance eligibility, no patient is ever turned away from Presbyterian. The N.C. Justice report recognized Presbyterian Healthcare in February 2010 as having the best charity care program in the state.
Charity care may not sound like a cornerstone for navigating a large organization through tough economic times, but Billings believes it’s crucial. After all: “If all our activities center on the patient, the rest will take care of itself.” And that’s a healthy approach we can all celebrate.