System strives for stability

As the UNC Health Care system begins to implement cost-cutting policy changes, officials find themselves in a constant tug of war, caught between hopes of increasing profits and maintaining quality care.

But top officials remain optimistic that the system’s image of quality will remain untainted.

As the state’s nonprofit hospital, charged with providing quality care for all North Carolinians regardless of income, the system is working to attain stronger financial stability.

The $40 million that the state allocates annually to the system for costs of care and parts of graduate medical education are insufficient in covering all expenses incurred, officials said.

“That means that we have to be more efficient in delivering care,” said Karen McCall, vice president of public affairs and marketing for UNC Health Care.

While efficiency is key, quality is a top priority, said William Roper, chief executive officer of UNC Health Care.

“We are continuing to explore every option for becoming the strongest public health care system possible,” Roper wrote in an e-mail.

The system — which employs 6,000 people — recently eliminated 200 positions, and all employees affected now are being offered other open positions within the system.

Because there usually are more than 200 vacant positions in the health care system, workers are able to transition seamlessly into open jobs, McCall said.

“Our workforce is our most important resource,” said Roper, who also serves as dean of UNC’s School of Medicine.

“Being able to keep these employees in our system is of great value to us.”

More than half of the displaced workers already have been reassigned across departments.

About 36 displaced employees have been offered different positions, and about 20 of those have switched to their new positions in the last three weeks, McCall said.

“We’re trying to place people in new positions that match their skills,” she said.

“We’re trying to offer them as many choices for those positions as possible, and we’ll work with the managers in the areas that they’ve been placed in to make sure that they have adequate training opportunities for their new positions.”

Vernon Brown, one of the displaced workers, said he was grateful to retain a job in the hospital system, especially one that does not require a dramatic change of responsibility.

Brown, who served as executive assistant to the head of the women’s and children’s hospitals, now is an executive assistant to the medical director and vice president of ambulatory care and the director of clinical business operations.

“They went the extra mile and tried to find another position for people that were involved in this,” he said.

Brown said the transition is running smoothly because most workers are cooperating with the job changes.

Doctors also have high hopes for the changes.

“From what I’ve read and the meetings I’ve gone to, if indeed they can implement all the changes, it will be better for the physicians and the patients,’’ said Dr. Robert Berger, professor of medicine and director of medical informatics for UNC Health Care.

“People will get in and out quicker, and you’ll be able to come in and put your information online faster. This is a long-term process.”

He said this would mean not only a more fluid process, but one that benefits the hospital financially.

“Hopefully, the institution will be more profitable. Those are the goals: better care and more profitability.”

As a nonprofit organization, the health care system eventually aims to make 3 cents on every dollar of its revenue.

UNC Health Care has created more than a dozen task forces to improve efficiency and to better its financial future, McCall said.

“Hospitals around the nation are dealing with fluctuating volumes, decreasing reimbursement and increasing costs,” Roper said.

“Our Performance Improvement Project — which includes access, billing, (operating-room) services, bed allocation … and staffing — are all ways to address these issues.”

The system is aiming to implement most changes in the next 12 months to 18 months, McCall said.

Among other goals, the organization wants to make sure that everything is billed correctly and that appropriate amounts of money are collected.

The system also aims to make it easier for patients to be admitted to and discharged from the hospital.

To help reach this goal, the clinical resource management, social work, pre-authorization and bed assignment departments are merging under one roof in the new Clinical Care Management Department.

“The Clinical Care Management Department embraces each of these important initiatives and will be a single, streamlined department that improves patient access,” Roper said.

Hospital officials also said they think operating-room scheduling and bed allocation will become more efficient by decreasing turnover time, coordinating start times and proposing new policies for operating-room use.

UNC Hospitals will no longer limit patients’ bed assignments to areas of the hospital designated for their particular needs because this system slows the admittance process, McCall said.

The system is making every effort to avoid wasteful spending, and by consolidating supply contracts, the system has saved more than $1.6 million since July, McCall said.

“We’re continuing to monitor every new vacancy we have as to whether or not we want to immediately fill it,” she said. “We’re looking very carefully at everything we spend money on.”

The system now is projecting the amount of revenue it will earn and the expenses it will incur in the next fiscal year.

Roper will present the projected budget to the UNC Health Care system board in May.

The current primary objective of the system is to maintain efficiency and quality care — a balancing act further complicated by a small budget, McCall said.

“The main issues that we’re facing is that we’re trying to improve our quality, and at the same time, we’re trying to improve all of our processes to provide excellent care for all of our patients.”

 

Contact the University Editor at udesk@unc.edu.