CEO Spotlight

Dr Trenschel M.D. CEO of Yuma Regional Medical Center in Yuma, ArizonaToday’s blog comes to us from Dr. Bob Trenschel, Yuma Regional Medical Center CEO. Here he shares his thoughts on the success, challenges and the future of healthcare in Arizona through a two-part blog.  This is the first of the two. Once you’ve had a chance to read it, we’d love to hear your thoughts. Generating meaningful conversations around the health issues facing us here in Arizona is another way we are working to make our state the Healthiest State in the Nation!

  • What are the biggest hurdles to providing care?

The regulatory burden on healthcare always provides hurdles. The biggest hurdles impinging upon healthcare are always external, coming from the regulatory environment, insurance environment or the payer environment. When you get down the level of the nurse or physician providing care for a patient, that interaction is a thing of beauty. That interaction is the most important aspect of healthcare and that doesn’t change. But unfortunately, so many outside challenges are added that continue to present hurdles for healthcare providers.

For an example, the electronic medical record is a hurdle. As much as it’s been a benefit in terms of tracking and trending, providing higher levels of accountability, more legibility and patient safety, I think EMR has provided a hurdle to providing care because everyone is so worried about providing documentation. This takes attention away from the human being in front of you. You are looking at a screen instead of interacting with your patient, who is always your number-one priority. I think there is always hope, however. There will be better ways that we can document into the medical record. Maybe it’s voice operated through artificial intelligence. I long for the day when caregivers can get back to fully focusing on their patients as much as they clearly want. Regulatory burdens concerning opioids are another good example. This is an issue that definitely needed to be addressed, but I think some legislation goes maybe a little too far – is a bit reactive. We need to do better for our communities and there was probably too much of a free hand with prescribing opioids, but this becomes another matter of physicians not having enough time to deal with issues that relate to their patients.

I also think insurers provide an abundance of hurdles, including the length of time it can take getting a provider credentialed or getting a physician credentialed on health plans. Those lengths of time have been just exorbitant. We have to wade through all the denials you receive from health insurers for no apparent reason. When you bring a new provider into the community and you want to get them signed up with a health plan, it can sometimes take up to nine months. This is a problem across the country.

Claim denials also constitute a major problem, with 70-80 percent of claims being denial denied in some cases. It’s awful the games insurance providers play, especially since it requires so much rework on your end. There’s nothing wrong with the claim, so you have to get on the phone and appeal it. They bank on you just letting it go, not appealing it, which is never the right thing to do, of course, being good stewards of our finances.

I am appreciative that AzHHA has forced the credentialing issue. Now, as of Jan. 1, insurers have 100 days to credential a physician, to get physicians on their plan or they face stiff fines. That is great.

As leaders in healthcare, we want to create the optimum environment for providing care. As executives and administrators, we must try to remove those burdens. We obviously adhere to those regulatory burdens, but hopefully do so in a way as an organization that is seamless and nonintrusive.  We certainly aren’t doing this as much as I would like, but I think we are well on our way.

  • What is your facility’s greatest recent success?

I can’t say enough about the innovations we are seeing throughout YRMC, all thanks to the Lean processes we have adopted throughout the organization, at all levels. Lean is everywhere now. It’s a flywheel. It’s really going and I could not be more proud of our employees and leadership team. Lean has been a wonderful, three-year journey for us. We did a little bit in 2015, a little more in 2016, 2017 was really starting to flow and 2018 just really exploded with 500 projects. In just one year, we have seen more than $5.8 million in savings through Lean alone – all without losing any staff. That’s just one year, plus an increase in revenue totaling $5 million. That is huge for an organization like us. The staff has done that work. I am very proud of what our employees have accomplished. Many organizations don’t do this. Those that don’t constantly find new ways to keep evolving, keep innovating, they will either get absorbed by another health system, die a slow death or just continue in mediocrity, which is something we can just never do at YRMC. We don’t want to be on the bleeding edge, because that’s too far out there, but we do always want to be on the cutting edge.

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