Friday, May 27, 2016

5 Questions May 2016

Published in VC's Notes on May 27, 2016

Five Questions

Good morning and Happy Memorial Day weekend! We appreciate and honor those who have given their lives to protect our country and our freedom.  

Since it's the last Friday of the month, I'll answer some of your questions today. Before I do, I want to salute all of those who will be graduating from UMMC a couple of hours from now.  We have a record number of people--950--who will be collecting degrees at the Mississippi Coliseum. Our state needs every one of you, and I wish you all Godspeed.

Just as a reminder, I read all your questions and comments and appreciate them all. If I can't answer them in VC Notes, I pass them along to others for review and possible action.

Now, on to your questions.

Dr. Woodward, at the end of all your communications and at the heart of the mission of the Medical Center is "A Healthier Mississippi." With that end in mind, I am wondering why the health insurance policy provided to employees is so bad. Of all the places I have worked in my professional career, the health insurance here covers fewer things, has higher premiums, has higher deductibles, and produces more out-of-pocket expenses than any other policy I have ever had. If you want to make "A Healthier Mississippi," then why not start with giving better health insurance to your own employees? In my mind, change starts at home.

A:  The most basic answer is that UMMC employees are part of the State Health Plan and, as such, the Medical Center doesn't have any control over premiums, copays, deductibles, etc. I would also add that the employee-only monthly premium is relatively low--from $0 to a maximum of $38 per month--and very competitive with other organizations. As you move up the tiers of participation and add a spouse and children, the pricing does become significantly higher, but still within a competitive range when compared to other external reference points we track. The fact is, U.S. health-care costs are high, and that translates to high insurance costs. This is true for many reasons, but one important driver is that we as a population are not as healthy as we could be. Rates of obesity are higher in Mississippi than in most states, and too many people still smoke and engage in other risky behaviors that have negative health consequences. One thing I am encouraged by is that we have a newly reconstituted Wellness Committee, chaired by Dr. Josh Mann from the Department of Preventive Medicine, which is developing comprehensive plans to get employees more engaged in wellness activities. So while I agree with you that change starts at home, it also starts with each of us and what we can do to take charge of our own health.

CrosswalkQ:  Back in the 1960s the legislature passed a law giving all pedestrians on all college campuses the right-of-way. This was an important key to keep people safe on campuses across the state. Does this--and shouldn't it, if it doesn't--extend to the stadium parking? The advertising of pedestrians having the right-of-way and the enforcement of it could avoid injury and death due to the inherent dangerous situation we have involving cars and pedestrians.

A:  I asked our legal team to check on the law you mentioned and they could not find evidence of such a law.  They advise me that UMMC follows the state statutes regarding pedestrians and right-of-way, and this is also part of UMMC's policy regarding traffic rules and regulations. (You can find the policy here.) The essence of the law is that pedestrians on our campus have the right-of-way in marked crosswalks and at intersections, but must yield to traffic at other times. (Obviously, traffic lights at crosswalks govern when pedestrians may cross.) These same rules apply at the stadium.  However, since the stadium is essentially a set of large parking lots served by a few internal streets, special precautions should be taken by drivers and pedestrians alike. I would add that even though pedestrians do have the right-of-way in some situations on campus, you should never assume that a driver will stop; better to be safe than sorry. Also, I encourage our drivers on campus to be especially observant of pedestrians and to show them extra courtesy when conditions permit.  

Q:  Why is 4 Wiser, the med-surg overflow floor, not in the main hospital?  We have a whole floor in the main hospital that is just storage, sixth floor, which is now, according to the announcements on the home page of the Intranet, no longer going to be used for storage. So why don't we relocate 4 Wiser to that floor?  We would also be set up for telemetry which would save the hospital money. As of right now, whenever a patient gets an order for telemetry, we have to move them to the main hospital. We could also get a wider selection of patients which could help with ER wait times.

A:   The fourth floor of the Wiser Hospital was redeployed as a med-surg overflow unit a couple of years ago to accommodate fluctuations in our inpatient census. Later, as acute care admissions remained consistently high, we decided to keep the unit open on a full-time basis. As you indicate, 4 Wiser lacks telemetry, or monitoring equipment, but we are planning for that in our next capital budget. In the meantime, we were fortunate the 2016 session of the state legislature approved funding to build a Clinical Trials Unit (CTU) on the sixth floor of University Hospital, hence the request to move surplus equipment and furniture stored in what is now shelled-in space. As part of the planning for the CTU, we are going through a very deliberate process of evaluating other options that will help us deal with our high volume of patients. As I'm sure you can imagine, these options are like a 3-D jigsaw puzzle with many possible permutations and we are looking for the best fit with our needs and resources. As we go through this process, we will keep making the very best of what we have to work with while always putting our patients first.   

Q:  Years ago there was mention of changing to merit raises based on the individual employee's performance. Any future plans?

A:  I've been asked that question numerous times in VC Notes. We would like to one day move in the direction of merit-based raises and have had recent discussions about that. In the last few years, our focus has been on maintaining competitive pay for various position classes and keeping employee compensation as aligned with market fluctuations as possible. Because of limited resources, we've had to make tough decisions around whether to focus on selected position classes that are the farthest from the market versus smaller adjustments for all employees. A necessary condition of merit-based raises is that we have a strong and consistent performance evaluation system in place across the organization, and that's one reason we put special emphasis on the timely completion of duty-based evaluations earlier this year. Of course, a fact of business life is that regardless of the format we use to make adjustments in compensation, the funding has to be identified to pay for it on an ongoing basis. But if we are able to produce consistent financial margins by reaching our quality goals, gaining efficiencies in operations and tapping into new sources of revenue, then I would very much be an advocate of merit-based raises.

Q:  I am looking for a primary care physician. I am an employee here at UMMC. I have attempted to make an appointment with three different physicians here. Unfortunately, none of these are accepting new patients. As a matter of fact, I was told that I could see a resident at the Pavilion or I could go to a clinic across from Baptist Hospital. As an employee I would venture to say we are encouraged to see physicians here at UMMC. I understand how appointments and providing health care works. I imagine that outside patients are also trying to make appointments. I am sure they are frustrated and just go somewhere else for care. If they need a referral then they are sent to a specialist in that hospital's system. For myself, I do not want to see a resident. I am paying to see an experienced physician. Now I, too, am looking outside of UMMC.

A:  I'm sorry that we haven't been able to meet your needs. We've been working hard to improve patient access and scheduling for several years, and we've completely revamped our system during that time. We have made great strides but still struggle in a few areas. One consideration is that most of our physician faculty (primary care and subspecialty care) are not in clinic every day and not nearly as much as many of the outside community providers, especially the primary care providers, since our faculty have multiple administrative and teaching duties in addition to their clinical assignment. Add to that the fact that our physician ranks are still thin in a few subspecialty areas, so appointments are not as readily available. Even though you may prefer a faculty member to a resident provider, remember that all patients who are seen by a resident are also discussed with and seen by the attending faculty, who collaborate with the assessment and plan. In our Family Medicine clinics, for example, you can usually get an appointment within 48 hours if you accept the “first available” appointment. Although that will most likely be with one of our very fine resident physicians, you will also be under the care of a faculty member, and have the added satisfaction of supporting our education mission. 

Thank you for all of your questions. I wish I could say I have all the answers that would provide a quick fix for our capacity challenges, consistently give everybody a raise and provide a parking space closer to your worksite. Unfortunately, I don't.  But I believe we are making progress on many fronts, driven by your excellent work. And if we keep taking care of business, these and other good things will happen, on our journey to A Healthier Mississippi.



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