1. LOM: Growth
I’m Maureen Halligan, SVP of Strategy and Business Development and the convener for the Growth Metric.
I’ve been with CHISV for about 18 months and have been in strategy for more than 25 years.
I’m here today to ask for your help.

2. Why Grow? “If you’re not growing, you’re dying”
-Every self-help expert who ever lived
-AR volumes shrinking ~0.6%/year
What can an organization do if it has a growth mindset?
-Invest in its coworkers
-Upgrade its facilities
-Acquire new technologies
-Offer new services to its patients
-Provide more care to the poor and under-served
How many of you have heard this saying? If you’re not growing, you’re dying.
Usually it’s applied to personal growth. But the same holds true for organizations.
In our State, admissions are expected to decline more than ½ percent each year thanks to the work that the AHN.
If we don’t grow to offset that, we will be shrinking.
So, what can we do if we have a growth mindset?

3. So, are we growing?
How are we doing?

4. Admissions Trend
Here are our System admissions since we added Hot Springs in April Pretty flat.

5. ED Visits
Here are our ED visits over the same time period. Probably going down a little.

6. Surgeries
Surgeries?
Probably going down a little. We know we’ve lost some high volume surgeons and we need to replace that volume.

7. Clinic Visits
Clinic visits? Probably flat.

8. How are we doing?
How does that translate into our financial performance?

9. Financial Performance Update (Results through April)
Why has the financial performance slipped?
Investments (more FTEs, Raises, Market Adjustments) have been made in coworkers without more patient volume or revenue
Let me show you why growth is important.
Last year, we made about $30,000,000 before interest and depreciation.
That was tight, but we were surviving. If this were our personal budget, we might be able to put a little away for our kids’ college and fund our 401k
This year-not so good. We made some badly needed investments in our coworkers. There is nothing left to fund the other things we need.
Now I want to show you what the future could look like.

10. Recently we have engaged Chartis and Kauffman Hall to help us look at our market and help us determine just what we are capable of producing.
Here’s one of the slides they have shared with us. I am asking you to focus on the graph.
If we do nothing, we move into negative EBIDA in the near future.
Our current course will not allow us to continue to invest in our coworkers, or invest in equipment and technologies we need to care for our patients.
Our EBIDA expectation is 6% and we need to identify some initiatives that will take us from the darker line on to one of the higher trajectories.
There are 2 ways we can do that.

11. You can’t cut your way to prosperity
-Howard Shultz
Can we continue to cut?
Can we achieve our financial goals by continuing to reduce staff, reduce supply costs?
Can we continue to make do with $5 million a year in capital?
Cutting costs is part of what we will always do as a high-performing organization.
But we can’t cut our way to greatness.
We’ve got to increase volume and revenues.

12. What happens when we don’t accommodate one patient?
Now I’d like to share a personal story to help illustrate what happens when we don’t accommodate patients when they want to be seen

13. Impact of not accommodating 1 patient
Service
Contribution Margin
Surgery
$4,760
6 courses of chemo
$12,000
Port placement
$1,050
2 PET Scans
$1,000
Clinic visits
Labs ??
Missed CM
$19,810
I have a genetic mutation that predisposes me to cancer.
10 years ago, I got a little suspicious and called my OB-GYN’s office for an appointment. The soonest they could give me an appointment was in 5 weeks.
I had known and worked with this doctor for decades.
I called the University of Michigan Cancer Center an hour away. They saw me in a day or two. When the doc called me back with bad news, he had already made an appointment for me with the chair of the department for the next day.
Here’s what not accommodating one patient meant to the doctor I had known for years and to the hospital where I had worked for years.
Imagine if every time we can’t accommodate a patient when they want a clinic visit, or if we make them wait in the ER to be seen, $20,000 walks out the door.
And it’s not just for that visit, because once we allow our patients to go to our competitors, they might find that they like them.

14. The Ask
Say YES!
These are our family, friends, coworkers and neighbors
They are sick, they’re anxious, they’re worried
They have chosen us and put their trust in us
These folks on the phone or in the ED waiting room are people we know.
They trust us and they want us to take care of them.
So, here is what I need from you in 2018.
It’s going to require all of us to think differently and to work differently.

15. The Ask Say YES! Provide a clinic appointment quickly
Move them into the ED quickly
What if our competitors implement a 30 minute guarantee?
Eliminate LWBS
Help the ED by pulling patients to the floors quickly
Help reduce LOS
A 10% reduction in LOS would provide up to 20 open beds in Hot Springs and 30+ at SVI with existing staff
Help expedite discharges
Home by 1pm
Help promote CHISV!
I need your help to grow.
Give patients an appointment when they want to be seen. T
If they are in our ED waiting room, find a way to get them back quickly.
If we see 100,000 ED visits a year with a 3% LWBS rate, that’s 3000 people who walk out of the ED. If 25% of them would be admitted, it could generate another 825 admissions.
-If Baptist or National Park implements a 30 minute guarantee, will our ED waiting rooms empty out?
If you’re on a nursing unit, pull those admitted patients out of the ED
If you are someone who touches a patient in any way, help with throughput.
If we reduced LOS by 10%, and there is evidence that we have opportunity to do that, we could take care of more patients a day at our larger facilities without adding any more staff!
And help tell our story in the community

16. So…
Will you help?
So, before I open up for questions, I have a question for you…Will you help?