Internal memo sent to YKHC workforce written by Dan Winkelman, YKHC President/CEO
June 6, 2014
It has been a little over 100 days since I became your President & CEO and I wanted to provide you an update on our 100 Day Plan for Improvements.
100 Day Plan
As a reminder, the 100 Day Plan has three balanced and interrelated components: 1) increasing leadership visibility and engagement; 2) improving our patient’s experience; and 3) improving our financial performance.
1. Increasing Visibility and Engagement
Ensuring that leadership is visible and engaged with our workforce, patients and villages is important for any organization. It allows leadership to see and better understand the problems and perspectives you face and of those we serve. Over the last 100 days the Directors of the Board and I have met with our teammates and numerous tribal leaders in 11 villages with more planned. We have been to Hooper Bay; Scammon Bay; Kasigluk; Akiak; Kwethluk; Napakiak; Napaskiak; Atmautluak; Mekoryuk; Toksook Bay and Kwigillingok. I have also met with many of the tribal and non-tribal leaders here in Bethel, Anchorage and our region’s Senators and Representatives in Juneau.
The Board of Directors and I also recently began a new strategic planning process. We will need your help in developing this process over the summer months. You can expect me to continue rounding with our teammates in our facilities and I will be asking questions related to development of our strategic plan. I have also asked the senior leadership team to join me in rounding so we can engage as many of our fellow teammates as possible in our strategic planning process.
2. Improving Our Patient’s Experience
Cleanliness of our facilities and improving access to our outpatient, emergency department and dental clinics is essential. You may have noticed some changes already occurring throughout our facilities. Recently, we completed training our environmental service workers in the most current hospital cleaning techniques. This training was recorded and will be available online to clinics and other facilities as a training aid. We also have other hospital improvements that are planned or currently underway. This includes painting worn areas, purchase of new cleaning equipment and systems, and replacement of badly worn and damaged furniture in public areas. To help reinforce these efforts, we are asking all teammates to “lend a hand” and please pick up trash, report spills, and tidy up meeting and waiting rooms as you notice them.
We continue to work on improving our access to our outpatient and dental clinics. Despite our significant physician vacancy rate in outpatient clinics our providers have been able to maintain a steady third next available appointment rate of 16 days. We recently expanded our recruitment efforts to aggressively hire additional physicians and expect additional hires in the latter half of this year. The senior leadership team and I would like to express our heartfelt thanks to our outstanding group of providers for providing excellent patient care in spite of these challenges.
The dental department has improved access by changing their practice model and assigning three chairs per dentist as opposed to one chair. This best practice has significantly increased the number of patients our dental department can see.
We are also proud of the changes that have occurred in the emergency department this past spring with real time patient satisfaction surveys that show 85% of our patients feel that the care they received in the emergency department was excellent. In addition, the emergency department continues to work on improving its cycle and wait times. Over the last year and a half the average time in the emergency department has decreased from 6 hours to 3 hours. Currently the average time from registration to triage is 20 minutes.
Quyana to the teams that have and continue to drive improvement in those areas.
3. Improving Our Financial Performance
As you already know, YKHC experienced an $11.7 million operating loss. Even after this week’s reduction in force, YKHC is still projecting another multi-million dollar operating loss this year. With only a month into my new position, we immediately formed two plans: a plan to decrease our expenses and a plan to improve our revenue collections.
- A Plan to Decrease Our Expenses
This week has been difficult for all of us as we were forced to reduce our workforce due to very large past operating losses and a large projected budget shortfall.
We have, however, offered severance to all affected teammates and are assisting with job placement. Although it does not make the situation any better for affected teammates, my thoughts are with them and their families as I hope they are able to transition to new employment as soon as possible.
A final summary of this week’s reduction in force was a lay-off of 101 filled positions. This included: 51 positions within our Health Services Division, 43 in Support Services and 7 in Information Technology and Finance Divisions. Approximately fifty additional vacancies company-wide were also closed and will not be filled. At KYUK’s request, later today this information will be released to them.
As I mentioned last month, it was recently reported that YKHC received approximately $40 million to settle a lawsuit with the Indian Health Service (IHS) over unpaid contract support costs for years 2005 through 2011. Contract support costs are those costs incurred as a result of performing our health contract with the IHS to deliver health care to the people of the Yukon-Kuskokwim Delta. They are administrative costs like insurance, utilities, etc. The YKHC Board of Directors and I decided to safeguard these funds for a long-term hospital replacement project that would benefit the entire region, including villages. Therefore, these one-time funds cannot be used to pay for recurring annual budget expenses. If YKHC decided to use the settlement funds to subsidize our annual budget shortfall, at our current rate of spending, this entire settlement would be gone in four short years. Moreover, these funds are required by our bank to guarantee YKHC’s large line of credit that the company has used in previous years and will continue to need in order to keep YKHC operating.
- A Plan to Improve Our Revenue Collections
Improving our revenue collections, both short and long term, will be critical to improving the company’s financial performance.
As you will recall, I shared with you a few months ago that I directed an in-depth analysis of our revenues. We have looked at the processes we use to collect information to bill patients and insurers and are addressing other revenue cycle issues. Through these efforts, we are working hard to reduce our coding backlog. The coding of patient accounts is a necessary step in our revenue cycle that allows the company to bill for its services and collect necessary revenues to operate YKHC.
Due to the critical importance of these revenue issues, I formed and chair a team that has one goal, to ethically and lawfully improve our revenue collections. We will continue to meet weekly to ensure we are making adequate progress to improve our revenue collections and decrease our coding backlog. I am implementing metrics on my management scorecard to the Board of Directors in order to track our progress and keep this type of coding backlog from reoccurring.
- Pension Contribution Made in the Amount of $3.8 Million
Lastly, we are pleased to announce, as promised, on June 2, 2014 YKHC made a $3,885,681 payment to the retirement pension accounts of eligible participants. Those employees affected by the reduction in force who participated over the last year in the eligible retirement plans also received their discretionary employer contribution. We will address next year’s employer pension contribution in a future employee forum.
These past 4 months have been extremely busy. Trust that YKHC is working as fast as humanly possible to improve our revenue collections while we simultaneously take necessary actions to reasonably contain our expenses. Meanwhile, we must continue to produce high quality health care for the people of the Yukon-Kuskokwim Delta and keep that as our primary focus and commitment.
Quyana for all you do every day to provide the best health care possible to our patients.