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background resources in PDF |
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some CAM/IM publication links |
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Shore Health System: ExploringCAM-IM's Economic Value in Nurse Retention |
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Written by John Weeks
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Shore Health System: Exploring CAM-IM's Economic Value in Nurse Retention
 Shore Health System, Eastern Shore, Maryland
David Mercier, LAc, "clinical acupuncture specialist" - who effectively serves as director of integrative medicine - for the Maryland-based Shore Health System - has succeeded in developing a program at the Shore Health Center for Integative Medicine which has captured the
Shore Health Center
for Integrative Medicine:
At a Glance
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| Location |
Stand-alone
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Salaried (Mercier)
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.5 admin,
.5 clinical
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| Contract staff |
8
LAc, LMT |
FTE equivalent
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3 |
| Patients per month |
300 |
| Inpatient |
Reiki
program
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Years in operation
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5
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Bottom line
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Break-even,
with caveats
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system's attention for its very high patient-satisfaction on the Press Ganey scoring system used by many hospitals nationwide. He is now considering an unusual strategic direction - help in nurse retention - which may also implant the center as an important contributor to the hospital's bottom line.
In 7 of 8 testing periods
with the widely-utilized
Press Ganey survey, Shore's
IM department ranked
higher than all other hospital
departments -- most recently
with an overall 98.5
average score.
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The five-year-old, stand-alone Center is part of a system which serves
a population base of 135,000 on Maryland's eastern shore. The system
includes two hospitals and a range of other facilities such as primary
care, rehab and a cancer center. The Center's services focus on
acupuncture and massage, and sometimes include limited Yoga, tai chi
and Mind Body Stress Reduction. (The Center has also developed an
award-winning, inpatient Reiki program which will be the subject of a
future IBN&R article.)
No medical doctors or other conventional providers are onsite at the Center. Mercier, with a 50-50 administration/patient care split in his time, is the chief salaried staff person. He
notes that "after five years of struggle, the Center is now breaking
even." He shares, however, that in this accounting the cost column does not include rent or building
maintenance, which are covered by the hospital.
Shore Integrative Medicine Scores on the Press Ganey Patient Survey
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Overall, Integrative Medicine
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98.5% |
Overall, Acupuncture
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99.3%
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Overall, Massage
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99.2%
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Overall, (Conventional) Medical Practice
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88.8%
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 David Mercier, LAc
Each scoring has been by the widely-utilized Press Ganey system. This patient surveymeasures roughly three dozen characteristics of the
patient experience. These range from facility cleanliness, to the
skills pf providers, sensitivities of the providers, and the likelihood of
referring other people to the facility. In fact, in outcomes shared with IBN&R,
the "Overall Service Rating" for the Shore Center for Integrative Medicine averaged
98.5 on a 100 scale. This compares to a typical rating in the high 80s
for conventional medical services.
How CAM-IM Can Have an Economic Impact on Hospitals and Health Systems?
Shore has been pleased with these outcomes. Mercier notes that,
to the health system, the Shore Center for Integrative Medicine "adds value to
its image." Then he adds: "But from a business perspective, there is
really little the integrative medicine center can do to add to the
bottom line." He explains: "Even if fully booked" - and the Center is
approaching that status - "our percentage of the total hospital
revenues would be miniscule."
Mercier concludes that there are chiefly two strategies for creating a
more forceful impact for CAM-IM in the system. The first would be to
work to more deeply integrate the
How can the IM program
register economically when,
even fully-booked, the
Center's percent of total
hospital
revenues
remains miniscule?
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services into hospital inpatient services. To
understand this option, Mercier engaged "a little informal survey" of
other integrative programs around the country. He concluded that none
had significant in-patient penetration: "No one seems to be doing
anything comprehensive." He sees the problem structurally: "A hospital
system has a highly integrated architecture. The modules of diagnosis, procedures, supplies and billing all interface with a high degree of specificity. Putting CAM into that architecture, while not impossible, is a
considerable challenge." He chose not to focus his limited time and energy
there.
A second area is proving more intriguing to Mercier. What if
integrative medicine focuses not only on service to the surrounding
community but also on contributing to "the quality of life of the
employees." Mercier views the receptor sites within the system's
wellness programs, and even its employee benefits package, as more open
to a CAM-IM infusion. And the bullseye in his thinking is the
toughest personnel challenge in hospital care today -- the hiring and
retention of nurses.
CAM-IM: A Role in Hiring and Retention of Nurses?
The shortage of nurses is the big workforce mismanagement story in US healthcare planning. According to data from compiled reports on the website of the American Association of Colleges of Nursing:
- Roughly 75% of hospital vacancies are for nurses.
- US Department of Labor has called nursing the top profession for job growth through 2012, with over 1-million new nurses needed. (For reference, we have a total of roughly 770,000 medical doctors in the entire system.)
- In long-term care facilities alone, there are 100,000 open slots for nurses on any given day. These facilities pay $4-billion a year in recruitment and training.
- A survey found that nurses "see the shortage in the future
as a catalyst for increasing stress on nurses (98%), lowering
patient care quality (93%) and causing nurses to leave the profession
(93%)."
- The nursing shortage is viewed by 52% of doctors and 65% of the public as linked to medical errors. (See related IBN&R article on medical errors.)
Bottom line: According to estimates, the full, direct and indirect "turn-over" costs (not including costs, both financial and clinical, related to medical errors caused by shortages and the use of temporary nurses when are less familiar with system protocols) for a Registered Nurse, are typically estimated at $50,000 to $85,000 per nurse. This is a estimated annual national cost of $9.75 billiion dollars. For a 400 bed hospital, such costs are estimated as reaching $800,000 a year. Mercier figures that this is a good place to focus integration efforts for his team at Shore: "If we can help them retain just a few nurses, we can have an important economic impact."
The direction is yet new for the Shore IM team. States Mercier: "This is our line of inquiry. It's a strategy. There's a lot we think we can do. " But at this time the effort is yet "an idea with its feelers out." He has found a good deal of interest: "The chief nursing officer likes the idea." He has found informal support. But implementation of a focused strategy, if it comes, will not likely take place until later this year.
Comment: In the early days of integration, most of us thought the center of activity would be in exploring the benefits to health systems through better clinical care. Experience first taught us that health systems typically viewed integration, first, as beneficial to the PR Department. Now, here, we see the potential for benefits in Human Resources. The Department of Medicine is not yet the domain of principal inquiry.
In this nurse-retention
strategy, CAM-IM
services gain an
economic
alignment without challenging
the system's status quo.
With a seat at the hospital's
economic table, perhaps
dialogue can deepen.
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A survey of integrative medicine leaders undertaken as part of the second Integrative Medicine Industry Leadership Summit suggests a potential reason for this lack of medical penetration. Asked which of five top stakeholders in health care were viewed as having the highest "alignment of (economic) interest" with integrative medicine, hospitals and health systems ranked near the bottom. Only 18% marked it #1 or #2. [These positions were claimed by "consumers" (95%) and "employers" (42%).(See related article on employer interests.)] "Hospitals and health systems" ranked near the bottom, with HMOs and insurers.
CAM-IM services, with their preventive and health-creating focus, may have as their optimal global impact on health care the reduction in need for pharmaceuticals, procedures, surgeries and hospitalizations. To the extent that this is so, we see a strong mis-alignment with the capital-intensive, tertiary care economic center of health systems today - regardless of the system's expressed mission. The safe-money bet on the tug-of-war between mission and money in a healthcare system still goes with the established investment practices.
The direction Mercier and the Shore team are considering is an intriguing one, in this light. CAM-IM services can potentially gain an economic alignment with the broader system without deeply challenging the status quo in the way medical investment is prioritized. With such a seat at the system's economic table, perhaps the dialogue can deepen.
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