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BLOOMINGTON, Ind. (AP) — On a sun-splashed May afternoon in 2005, more than 100 people gathered beneath a sprawling white tent at the corner of Fullerton Pike and Ind. 37.
They were there to celebrate the groundbreaking for Monroe Hospital, a private facility that was the brainchild of two Bloomington physicians — pain doctor Kamal Tiwari and eye surgeon Dan Grossman.
The mood was festive. There were catered appetizers and desserts, goody bags, a wet bar, live music and valet parking by young men wearing white tuxedo shirts and black bow ties. The future of the new hospital looked as bright as a new penny.
After attendees took their seats on chairs draped with satin, Tiwari stood behind a lectern. As he scanned the crowd, his eyes grew moist and his voice cracked as he said, "As an immigrant American, I am excited and honored on this momentous occasion. I feel today as I did when I visited the Statue of Liberty for the very first time — privileged, honored, welcome and comfortable."
Grossman was next to speak, calling the groundbreaking ceremony an historic event for Monroe County.
"We've had one hospital in this area for the last 100 years," Grossman told The Herald-Times (http://bit.ly/1vYMQPS ). "We feel like we're the new hospital for the next century."
No one in attendance that day could have imagined that in September 2007, just 11 months after Monroe Hospital would open its doors, neither Grossman nor Tiwari would be associated with the hospital. A terse news release from Monroe Hospital LLC that month said the physicians had withdrawn from the company, sold their equity interests in the hospital and resigned from the hospital's board of directors.
To say that Monroe Hospital has had a rocky road since opening on Oct. 16, 2006, would be an understatement. It's had a revolving door of nine CEOs, amassed a mountain of debt, struggled to fill beds, laid off employees and closed departments. In August, Monroe Hospital LLC filed Chapter 11 bankruptcy and announced plans to sell its business to Prime Healthcare Services, a hospital chain headquartered in Ontario, Calif. The sale became official in November.
It should be noted that from the beginning, Monroe Hospital has had some undeniable strengths — short emergency room waits, convenient parking, all private rooms, only one "preventable error" in eight years, hospital-acquired infection rates among the lowest in the country and consistently high patient satisfaction rates.
Many patients have said their medical care at Monroe Hospital has been excellent, and they appreciate the hotel-like ambiance. Each private room features a spacious tiled bathroom and shower, a 26-inch flat-screen TV and a bedside wireless keyboard and data ports that enable patients to connect their laptops to the Internet. Patients have a view of garden courtyards filled with flowers and water features, and meals are served to patients in their rooms, in the hospital dining room or at an outside dining area on a private patio. The front lobby features a coffee bar, 15-foot-high water fountain, aquarium, two planter boxes with live trees and a pair of flat-screen TVs.
The hospital's first red flag surfaced in January 2007, when Monroe Hospital's CEO at the time, Dean Melton, said the facility was operating at less than half its capacity, and had asked Bloomington Hospital to become its business partner. The larger hospital said it was not interested. Two months later, Melton said the hospital was looking for more funding to stay financially afloat.
In September 2007, those associated with the hospital were stunned by news that Tiwari and Grossman were no longer associated with Monroe Hospital, the hospital they'd co-founded less than a year before. The two men sold their equity interests in the hospital to Vibra Acute LLC, which began managing the hospital.
The Herald-Times contacted Grossman and a half dozen local investors in Monroe Hospital, but none wished to be interviewed for this story. Attempts to reach Tiwari were unsuccessful.
Under Vibra Acute's management, Monroe Hospital appeared to be righting the ship. In November 2008, the hospital announced that from June 2007 to September 2008, its monthly net revenue tripled — from just under $1 million to $3 million. During the same 15-month span, the number of hospital employees rose from 220 to 330; monthly admissions increased from 75 to 103; monthly outpatient visits jumped from 750 to 1,473; monthly surgeries went from 125 to 273; and monthly emergency department visits climbed from 984 to 1,269.
In September 2012, Monroe Hospital got a promising shot in the arm when it signed a four-year agreement calling for St. Vincent Health — a Catholic 22-hospital health care system — to manage Monroe Hospital's operations. St. Vincent also signed an option that would allow it to buy the hospital. But 13 months later, St. Vincent broke off the agreement.
At that point, Monroe Hospital went into a death spiral. In March 2014, it laid off 17 of its 300 employees. Five months later, Monroe Hospital LLC filed Chapter 11 bankruptcy and announced plans to sell its business to Prime Healthcare. The bankruptcy papers said the hospital had more than twice as many liabilities as assets, and had general unsecured claims totaling more than $13 million.
New ownership
On Nov. 18, Prime Healthcare officially acquired Monroe Hospital, beginning what the hospital's patients and employees hope is a new era for the hospital.
"I've seen all the ups and downs," said Bob Lee, who has been an operations technician with Monroe Hospital since it opened. "I think this (Prime's acquisition of Monroe) is fantastic for the employees and the community. This is a company that really understands health care."
At a ribbon-cutting last month celebrating the new ownership, Jim Summersett, Monroe's interim CEO, admitted the hospital's first eight years have been challenging, but promised things would be different with Prime, which focuses on buying and operating hospitals under severe financial distress.
"There is tremendous assurance that Monroe will be here tomorrow," he said. "We have the best supplies and equipment for our patients, and we already have a great facility that Bloomington can be proud of."
Prime Healthcare certainly has its share of critics. It has been investigated over accusations of "upcoding" medical bills — billing for higher-paying services than were actually performed — and for reporting an unusually high number of rare ailment diagnoses. Prime has also been fined for violating patient confidentiality, and the Service Employees International Union says the hospital chain has a history of closing service lines, initiating layoffs and cutting its employees' wages and benefits.
Summersett, who's also CEO for Prime Healthcare Services, said Prime rarely closes service lines, and that while Prime often reduces staff when it first buys a hospital, the people who are let go often get rehired within months. He also said Prime does not upcode, and has never been fined for doing so.
"What we do is on the up-and-up," he said.
Prime Healthcare hospitals have been recognized among the nation's "Top 100 Hospitals" 27 times by Truven Health Analytics, and last year eight Prime hospitals made the "Top 100" list. Prime Healthcare has been recognized as one of the "Top 15" Health Systems" in the nation three times.
Billing practices
Summersett said Monroe Hospital can stop its flow of red ink by improving its billing practices.
"Financially, we work very hard on the revenue side — getting paid for what we do — and that starts with the documentation of the patient's condition put into the patient's record by the attending physician," Summersett said. "Prime has made a science out of understanding how documentation translates to coding and how coding translates to reimbursements — with the intention of getting paid for the work we do."
He said Prime Healthcare has an entire department that oversees the billing practices of the 30 hospitals it owns and operates in 10 states. Prime recently hired a "clinical documentation specialist," who will spend time working with the hospital's attending physicians, helping them with their documentation and making sure patients admitted to the emergency department who should then be admitted to the hospital are indeed admitted. The specialist will start sometime in January.
"Some of the successes we've had turning hospitals around have spurred questions about our business model and some of our methods," Summersett said. "Often, if our documentation is better and leads to higher coding, people will say Prime is out of line. Our answer is that we are simply doing a better job of documenting the condition of our patients."
Summersett said Prime has a "relentless commitment to quality of care and patient satisfaction," and uses "proven clinical protocols and a lean management structure that is very physician friendly."
Trending upward
The early numbers indicate the hospital's financial trajectory is on the rise.
Comparing October 2013 with October 2014, hospital admissions climbed from 79 to 95, days of cash-on-hand rose from -.02 to 13.8, net days in account receivable dropped from 50 to 46, and average length-of-stay decreased from 5.4 to 4.3.
Summersett said the decline in "average-length-of-stay" is a positive sign for the hospital, because Medicare pays hospitals for care based on a set payment called a "diagnosis related group" or DRG. The DRG is determined by the number of expected days a patient would typically stay in the hospital and the intensity of care a patient would typically receive during that stay.
"The hospital receives the same payment, regardless of how long the patient actually stays or how many resources the patient may use during that stay," he said. "The longer patients stay in the hospital, the more resources they will use and the costlier the care. The art of being successful is being able to manage the care of patients within the amount of dollars allotted by the payer to pay for the care."
Summersett said another positive trend is a decline in the number of "observation patients" from 25 in October 2013 to seven in October 2014. Observation patients are patients who come to the emergency department and are observed for up to 48 hours, until the attending physician decides to either admit or discharge them.
"Observation patients are treated the same way in-patients are treated, because they are in the hospital, but their treatment is reimbursed on a much lower outpatient basis," he said. "We've implemented an admitting criteria that's made the decision-making go more smoothly, and reduced our number of observation patients."
Summersett said the hospital must drive up its inpatient numbers, and the key to filling inpatient beds is bolstering its emergency department volume.
"It starts in the emergency department, which is the front door to any hospital and an excellent way to build patient volume," he said. "Prime is spending a lot of time focusing on the quality and efficiency of our emergency department, because there's an old saying that the product always comes before promotion."
He said those who visit Monroe's emergency department are seen by board-certified physicians rather than a nurse practitioner or a physician's assistant; and have an average wait time of less than 20 minutes.
Summersett said Monroe Hospital is averaging only 30 patients a day in its emergency department, but he hopes to see that figure climb to 70 to 80 a day in the coming months.
In late November, Prime began running a series of ads in The Herald-Times, touting its emergency department's short wait times, lab services, diagnostic imaging and intensive care unit — while highlighting its location at the intersection of Ind. 37 and Fullerton Pike. Billboards trumpeting the same message will soon follow.
"The main challenge with Monroe Hospital, from a marketing standpoint, is creating more awareness about where we're located," Summersett said. "If you don't know how to get there, you will probably not go there."
2 clinics shut down
Monroe Hospital has shut down two of its three primary care clinics — one in Bloomfield and another on Sare Road — that were part of the Monroe Medical Group. That resulted in a handful of practitioners being laid off. Since Prime took over Monroe Hospital, it has reduced the hospital's staff by about 25 people. It now has 350 employees.
"We are trying to consolidate our overhead by putting all our (clinic) operations, for the most part, at our Landmark Avenue facility," Summersett said. "We're working to figure out what that medical group will look like in the end."
Summersett said the hospital is close to hiring a business development director and hopes to recruit new physicians now that the hospital has emerged from the bankruptcy process. He said the hospital hopes to hire a permanent CEO very soon. He said staff morale is high.
"Over the years, this hospital has been through a lot of false starts and sudden stops, and the financial uncertainty of the hospital has kept them awake at night," Summersett said of the staff. "But now that they're seeing some tangible improvements that are making their lives better, and seeing a bright future for the hospital, I'm sure they're sleeping a lot better."
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Information from: The Herald Times, http://www.heraldtimesonline.com
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