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On the Road with Ray

On the Road with Ray: California Dreaming and Vegas, Baby!

Posted on Mon, Dec 12, 2016
On the Road with Ray: California Dreaming and Vegas, Baby!

Earlier this year, EmCare’s Executive Team launched a “road trip” initiative to better connect with providers in the field, recognize teams that are Making Healthcare Work Better™, and brainstorm with those that may be struggling on how to overcome the challenges they are facing.

The recurring “On the Road with Ray” feature will highlight these visits and the dedicated clinicians who are providing care at EmCare sites across the country.


By Ray Iannaccone, MD, FACEP, FACHE

When EmCare signs a contract with a healthcare client, it truly partners with the facility. We meet with the facility’s administrators to discuss their specific challenges, opportunities and goals, and begin the important work of assembling a strong, permanent, local team of clinicians to provide care. Not infrequently, these partnerships develop into long-lasting, symbiotic relationships with shared risks – and shared rewards.

Our partnership with Universal Health Services (UHS) is one of those partnerships. EmCare’s joint venture with UHS allows both organizations to leverage their respective strengths in a more formal, integrated capacity. Our interests are aligned, so decisions are coordinated and care delivery is more efficient.

I visited several facilities that are involved with this partnership as part of my “On the Road with Ray” travels. During my trip to southern California, I met with James Rhee, MD, regional medical director in EmCare’s West Division. We visited Southwest Healthcare System, which consists of the 120-bed Rancho Springs Medical Center in Murrieta, and Inland Valley Medical Center, a 122-bed hospital and trauma center in Wildomar. We’ve provided hospital medicine services at Southwest’s hospitals since 2014 and recently added emergency medicine. Combined, both facilities average more than 5,000 patients each month in their emergency departments and more than 4,000 inpatient encounters each month on their hospital medicine services.

We met with the operations team and hospital administration at Rancho Springs and toured the hospital. I met several EmCare-affiliated clinicians and was able to hear their thoughts and concerns first-hand. As at most facilities, communication between providers at Rancho Springs can be a challenge, and I learned how competition, compensation and benefits are impacting our ability to recruit clinicians.

Dr. Rhee and I then met the hospitalists at Inland Valley for lunch, followed by a roundtable discussion with our providers and the CEO of the system. We had a great discussion about creating and fostering a strong team to improve operational efficiencies, and ways that we can leverage the system’s successes.

We then visited Corona Medical Center, where we toured its busy emergency department and met with the clinical team. We capped the day with a dinner nearby. Clinicians from all three hospitals were invited, and we had a casual but productive meeting.

My Vegas Visit

Las Vegas is an important market for EmCare and our parent company, Envision Healthcare. We provide care across the continuum in Vegas through all three of our main business units: EmCare, AMR and Evolution Health.

I met with Flip Homansky, MD, regional medical director, to tour UHS-affiliated sites Centennial Hills Hospital Medical Center, Desert Springs Medical Center and Summerlin Hospital Medical Center. We had a leadership breakfast at Summerlin with hospital administrators, Frank Pape, DO, the site’s medical director, and Paul Silka, MD, FACEP, chief executive officer of EmCare’s West Division, followed by a tour of the 502-bed facility.

Las Vegas is a dynamic city that’s going through another remarkable phase of growth. Two million people call the city home, and an additional 400,000 can flood the area on weekends. Despite being served by six emergency departments and two critical access facilities, the city is still short on hospital beds. The EDs that we manage are dealing with boarding issues. Our combined teams are working together to develop solutions to improve throughput and alleviate bottlenecks.

I appreciate the time that our clinicians took to meet with me and explain the challenges that they are facing. It’s information that I can share with leaders at all levels of our organization and at UHS. Collaborating to find innovative solutions is one way that we’re Making Healthcare Work Better™.

On the Road with Ray United Healthcare Services

Visit EmCare's Facebook page for more photos from Ray’s trip! And, if you would like to suggest your site for a future visit, please contact ray@emcare.com.

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On the Road with Ray: Hoosier Edition

Posted on Mon, Oct 24, 2016
On the Road with Ray: Hoosier Edition

Earlier this year, EmCare’s Executive Team launched a “road trip” initiative to better connect with providers in the field, recognize teams that are “making healthcare work better,” and brainstorm with those that may be struggling on how to overcome the challenges they are facing.

The recurring “On the Road with Ray” feature will highlight these visits and the dedicated clinicians who are providing care at EmCare sites across the country.


By Ray Iannaccone, MD, FACEP, FACHE

When operations at a client site are going well and the team is humming along, we try to find ways to replicate that success at other EmCare sites.

That’s one of the reasons that’s I’ve been visiting a variety of hospital sites over the last few months. It gives me a chance to understand the culture and leadership at a site, and to connect with the clinicians that are knocking it out of the park.

Andy Mulvey, MD, FACEP, regional medical director, invited me to the Hoosier State to meet with the team at Community Hospital South (CHS) in Indianapolis. In the four years that we’ve been at CHS, our team has implemented a very successful E.D. Optimization Model, which focuses on delivering the best patient experience possible. In that time, our colleagues have netted:
 

  • Left without treatment (LWOT) rates that have remained at an average of 0.38 percent for the last year, compared to the Emergency Department Benchmarking Alliance (EDBA) national median of 2.80 percent and the CMS median of 2.10 percent
  • Median door-to-provider times of 24 minutes, compared to the EDBA median of 29 minutes and CMS median of 25 minutes
  • Volume increases from 34,000 to now more than 50,000 annual E.D. visits
  • Overall Patient Satisfaction Emergency Department Top Box scores of 88.2 percent in Q1 2016, putting the hospital in the 98th percentile nationally

I was eager to meet with the emergency medicine physicians, hospitalists, advanced practice providers, scribes and administrative staff who’ve been able to work together to improve care for patients – and improve efficiency for our hospital partners. People like physician assistant Jack Bonham, physicians Jake Dickinson and Ryan Bence, and three of the original “Amigos,” Drs. Ed Stone, Ron Leach and Eric Bennett. Our informal talks touched on everything from trends in emergency medicine to the upcoming election to our kids.

I also met with Community Health’s nursing leadership, who have been instrumental in supporting the changes that we’ve made at the hospital. A collaborative, collegial environment is a great breeding ground for innovation and efficiency. In fact, the optimization model is so successful that we’re implementing it at another site in Indiana, Franciscan Health Lafayette East.

After touring the emergency department at CHS, I visited EmCare’s regional office in Indianapolis. There, I met with Joe Wynn, vice president of client administration; Brad Runge, director of client administration, and other members of EmCare’s support staff, who brought me up to speed on our Midwest operations.

Hearing from our non-clinical staff, those dedicated, talented folks who help support our clinicians and make sure functions like recruiting, finance, credentialing, business development and account maintenance are completed timely and accurately, enables me to understand all aspects of our operations and troubleshoot any issues that may exist. I’m grateful for the time the staff was able to spend with me. And, with Envision Health’s recent acquisition of Ann Arbor, Michigan-based EPMG, integrating and enhancing our Midwest operations is even more critical.

An intimate working dinner at a local steakhouse capped off my visit to the Hoosier State. It was a great trip, and a great steak!

I’m proud of the success that our clinicians are having in the field and the day-to-day efforts of our support staff. One by one, we’re all making healthcare work better.

Visit EmCare's Facebook page for more photos from Indiana! And, if you would like to suggest your site for a future visit, please contact ray@emcare.com.
 

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On the Road with Ray: Dr. Iannaccone Visits Palms West Hospital

Posted on Mon, Sep 12, 2016
On the Road with Ray: Dr. Iannaccone Visits Palms West Hospital

Earlier this year, EmCare’s Executive Team launched a “road trip” initiative to better connect with providers in the field, recognize teams that are “making healthcare work better,” and brainstorm with those that may be struggling on how to overcome the challenges they are facing.

The recurring “On the Road with Ray” feature will highlight these visits and the dedicated clinicians who are providing care at EmCare sites across the country.


Located in the greater West Palm Beach area amid gated communities and polo grounds, Palms West Hospital is a vibrant, growing facility that serves patients across the economic scale.

Because the hospital is near bustling coastal resorts and a stone’s throw from working farms, EmCare’s emergency department teams at the site – one focused on adult patients and second dedicated pediatric team in an adjacent unit – see everything from equestrian falls to migrant worker injuries to a spike in the winter when northerners descend on the area for a reprieve from colder temperatures.

Despite being in a beautiful and balmy location, John Halpern, DO, chairman of the Emergency Department, admits that recruiting quality physicians has been a struggle, as there are competing hospitals vying for the same candidates. This challenge is one of the reasons why Dr. Halpern asked EmCare’s President, Ray Iannaccone, MD, FACEP, FACHE, to visit his site.

“I think it’s important that the company’s executives hear from the ground troops – the men and women providing care in our EDs,” explained Dr. Halpern. “It’s a new step for EmCare, and I wanted our team to be able to get more engaged with the company.”

But this meeting wasn’t the first time that Dr. Halpern had met EmCare’s president; When Dr. Iannaccone was an emergency medicine intern in the U.S. Navy, Dr. Halpern was his attending physician at Portsmouth Naval Medical Center. It’s a small world, indeed.

The visit provided an opportunity for the company’s administration to better understand the culture at Palms West and brainstorm ways to capitalize on the facility’s advantages for clinicians. These discussions included Erika Vazquez-Cuffe, MD, medical director of pediatric emergency medicine; Venkat Kalidindi, MD, executive vice president; Michael Davis, FACHE, division client administrator; Palms West CEO Eric Goldman, and several Palms West emergency physicians and advanced practice providers.

While Dr. Vazquez-Cuffe has only been at the helm of the pediatric ED since November 2015, she and her team have been able to make significant progress in improving key clinical metrics.

“Palms West is in a great area and it has strong relationships with local emergency medicine residency programs, which is a plus,” Dr. Iannaccone said. “Its pediatric services are a real differentiator in the market, and I’m proud of how EmCare has been able to partner with the hospital to grow that offering.”

The hospital, which sees about 140 ED visits a day, chiefly serves young families and affluent adults. It doesn’t see a high percentage of seniors in the off-season, but during the winter, the senior population in the area can spike significantly.
 
A key topic of discussion was the facility’s sepsis initiatives and how the team plans to meet national guidelines. And, like most EDs, Palms West relies on referrals to grow its volume, so EMS outreach also was discussed.

“We sat down and had a heart-to-heart talk about the challenges and opportunities that we have here,” Dr. Halpern said. “Several clinicians had specific questions for Ray, and he committed to looking into their concerns. It was a positive meeting and I’m glad that I reached out to him.”

After touring the facility and speaking with the hospital’s administrators, Dr. Iannaccone and several clinicians had a dinner meeting at a local restaurant to continue their discussions.

“They have a good team at Palms West, and we’re going to work together to find ways to recruit more residency and fellowship-trained physicians and continue to improve outcomes,” Dr. Iannaccone explained. “Our clinicians now know that the Executive Team cares and that we’re listening, and we’re here to help.”

“It was great to meet Dr. Iannaccone,” Dr. Vazquez-Cuffe. “We feel privileged that he has taken time from his busy schedule to show us his support. We feel confident that he supports the growth and betterment of our staff.”



Visit EmCare's Facebook page for more photos from Palms West! And, if you would like to suggest your site for a future visit, please contact ray@emcare.com.
 

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On the Road with Ray: EmCare’s President Visits Terrebonne General Medical Center

Posted on Mon, Jul 18, 2016
On the Road with Ray: EmCare’s President Visits Terrebonne General Medical Center

EmCare’s President Ray Iannaccone, MD, FACEP, FACHE, recently launched a “road trip” initiative to better connect with physicians in the field, recognize teams that are “making healthcare work better,” and brainstorm with those that may be struggling on how to overcome the challenges they are facing.

The recurring “On the Road with Ray” feature will highlight these visits and the dedicated clinicians who are providing care at EmCare sites across the country.

 
Timing is everything. When Joni Claville, MD, ran into EmCare’s President Ray Iannaccone, MD, in the hallway at the company’s Annual Leadership Conference in Las Vegas, she took a chance and invited him to visit Terrebonne General Medical Center, where she is assistant medical director of the emergency department.

“He seemed very approachable,” Dr. Claville explained. “During his presentation at the conference, he talked about his vision for EmCare, and how he wanted to get more physicians engaged at all levels. When I saw him, I knew I had to tell him about the great things that we were doing at Terrebonne.”

“Our executive team’s first priority is connecting more with our clinicians in the field,” Dr. Iannaccone explained. “We know that it’s impossible to do that from our offices, so I’ve challenged our team to find ways to meet and really engage in meaningful conversations with our employees. We won’t know what’s working and what isn’t if we don’t listen to the men and women who are on the frontlines delivering care every day.”

Dr. Iannaccone had a trip to New Orleans scheduled, and said he and several members of EmCare’s executive team would gladly stop at the Houma, La.-based hospital.

Dr. Claville, Owen Grossman, MD, the Site Medical Director of the ED at Terrebonne General; Michael Isabelle, MD, Regional Medical Director, and several members of the medical center’s administration, including CEO Phyllis Peoples and Vice President of Physician Practice Partners, Sid Hutchinson, met with Dr. Iannaccone; David Marks, EmCare’s Chief Operating Officer, and Terry Meadows, MD, Chief Executive Officer of EmCare’s South Division. They toured the facility and got to see the day-to-day operations in the emergency department.

“It was an intimate meeting. Everyone got a chance to get to know one another, and it was a great opportunity for us to discuss what was working and where we could work together to improve and grow,” said Dr. Claville.

“It was very impressive to hear about all of the forward-looking initiatives going on at the hospital and in the community,” said Dr. Iannaccone.  In 2014, Forbes ranked Houma as one of the fastest growing small cities in the United States. Nevertheless, with Houma being a small metropolis with a comparable physician base, “The environment created at Terrebonne General keeps people connected and interested. They are doing it right,” said Dr. Iannaconne.

A Track Record of Success

When Terrebonne General’s ED leadership set a goal of increasing Press Ganey survey scores for ED Physician-Patient Perception Measures for “Overall Communication with Providers,” it was a collaborative effort between EmCare and the medical center to meet the metric.

EmCare sponsored patient perception communication workshops, customized for Terrebonne, which focused on best practices to improve the patient experience, including:

  • Teach Back, a method to confirm patient and caregiver understanding of the course of treatment and follow-up care
  • Outstanding leadership and participation
  • Coaching techniques for improving patient communication and the use of AIDET®, the Studer Group® communication tactic

The initiative netted positive results: ED Physician-Patient Perception Measures improved by 60 percent from the first quarter to the fourth quarter of 2015.

A continuation of this collaborative spirit, the visit was more than just a meet and greet among executives, especially for Dr. Claville, who’s been with EmCare since residency.

“This meeting solidified how I feel about this organization,” explained Dr. Claville. “It was like talking to a group of friends. They really wanted to hear what we had to say and provided solid feedback. They made us feel like we were important. That’s great for a small facility like ours that can get lost in a large organization with much bigger clients.”
 
On the Road with Ray

Dr. Claville admits that when she completed her residency, she was very reluctant to join a large national physician practice. However, when she toured a few EmCare facilities and spoke with emergency medicine leaders within the organization, she said she felt like the company could offer the right balance of national opportunities and localized support.

“Although the company is large and growing exponentially, it still has its fingers on the pulse of the people – its employees,” she said. “That was and still is important to me and to my staff.”
Regarding the impact that Dr. Iannaccone’s visit had on the facility, Dr. Claville said that the conversations that day helped “plant the seeds” for further growth and collaboration between the organizations – a “win-win for everyone.”

Check back for the next installment of On the Road with Ray! And, if you would like to request that Dr. Iannaccone visit your site, please contact ray@emcare.com.

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