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OT: Failed Leadership 2.0


73Billiken

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https://www.stltoday.com/news/local/education/budget-shortfall-at-slu-could-mean-layoffs-program-cuts/article_fdea4be2-1650-52a3-bc8b-2cb7db831b9c.html#tracking-source=home-top-story-1

"SLUCare, the university’s academic medical practice, saw both a “sudden and significant” loss in revenue and a jump in expenses from implementing a new electronic health records system in the fourth quarter of fiscal year 2018, according to Pestello. It ran a “significant deficit” during the first quarter of this fiscal year, a trend that was projected to continue as increases in expenses outpace revenue from patient care.

While there may be increased costs associated with a new system implementation that should not be the cause of this budget shortfall (who was in charge of implementation and what recourse do you have with the outside consultants that implemented the new system?).

The major problem here is how did the 'sudden and significant' loss in revenue occur?  Did the SLUCare not bill their customers?  Did SLUCare miss the window on Medicare reimbursement?  

Sudden and significant revenue losses just don't occur.  Perhaps the Board of Trustees need to ask some hard questions of Doctor P and company.  

Hello Rome?  We have a problem......

 

 

 

 

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2 hours ago, 73Billiken said:

https://www.stltoday.com/news/local/education/budget-shortfall-at-slu-could-mean-layoffs-program-cuts/article_fdea4be2-1650-52a3-bc8b-2cb7db831b9c.html#tracking-source=home-top-story-1

"SLUCare, the university’s academic medical practice, saw both a “sudden and significant” loss in revenue and a jump in expenses from implementing a new electronic health records system in the fourth quarter of fiscal year 2018, according to Pestello. It ran a “significant deficit” during the first quarter of this fiscal year, a trend that was projected to continue as increases in expenses outpace revenue from patient care.

While there may be increased costs associated with a new system implementation that should not be the cause of this budget shortfall (who was in charge of implementation and what recourse do you have with the outside consultants that implemented the new system?).

The major problem here is how did the 'sudden and significant' loss in revenue occur?  Did the SLUCare not bill their customers?  Did SLUCare miss the window on Medicare reimbursement?  

Sudden and significant revenue losses just don't occur.  Perhaps the Board of Trustees need to ask some hard questions of Doctor P and company.  

Hello Rome?  We have a problem......

 

 

 

 

Actually, this is the norm rather than the exception. Far be from me to sympathize with Freddy P, but implementing a new EHR is a costly endevour. The implementation costs alone are very significant, but you have the physicians with a reduced schedule (usually 50% reduction during go-live) for awhile that you hope can go back to 100% before too long. Much of this will depend on the age and tech saviness of staff. Then, you have training deficits for physicians, nurses, front/back office staff. There are probably issues with inbound and out bound referrals, how to work those referrals and ensuring patients are adequately scheduled. A big problem is just getting the physicians to document in a timely manner and making the notes ready for billing. The other integrations (i.e. imaging, pharmacy, lab) will slow down billing and operations if not fine tuned.

Now, should most of this have been projected in the budgets....YES. However, you never really know how all the physicians will react and what other factors will effect revenue. Health systems have gone bankrupt due to a botched EHR implementation.

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When does FP finally start to get the blame and the BoT? Rome is burning. Instead, typical SLU, have the people who cause all the problems and put them in charge of fixing the problems they caused! Definition of insanity. I’m just waiting for somebody from leadership to say “you have no idea what you are talking about” or “we had a record fundraising year” or “you are a troll.” It’s a joke, leadership across the board is a joke and it’s a sad situation. Compounding of stupidity. 

Or just blame Father B! Ya that’s the ticket! All his fault! As usual....

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I actually just got notified of this via my daily email from Becker's. Looks like there is a lot more going on here than just an EHR rollout. Agree that the buck stops with Fred on this and we better implement some changes quickly.

 

https://www.beckershospitalreview.com/finance/slu-physician-group-implements-hiring-freeze-after-ehr-rollout.html

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With the possible exception of Biondi, who was really involved in details, Presidents and Boards deal with broad issues and assume those in charge of the individual units below them (people who they trust) are taking care of the implementation and details. When something blows up it is frequently a mystery to the Board why such a thing has happened, because what they are hearing from the ones in charge below them is that things are working properly and moving along according to plan. This is what CYA is all about, hiding stuff and passing the blame along. I will make the wild assumption that the new electronic health records system was purchased because it promised lots of benefits and cost savings that it did not deliver. I cannot say, of course, whether the real issue is with implementation, failures in budget planning, or scheduling failures. There is another, much worse cause for the sudden revenue shortfall, that of differences in opinion with CMS about the validity of the billing resulting from the new EHR. This is really a bad problem to deal with IF it is part of the problem. 

Nashville Billiken, yes, these problems tend to spread and involve LOTS of issues in a relatively short amount of time.

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The problems with SLUcare are multifaceted and have been brewing for years. We do not have anything close to the research revenue or resources that other high end medical centers rely on as their bread and butter (see our neighbors down the street). Instead, SLU has focused more on direct care rather than research (not that that’s a bad thing), but it doesn’t usually bring in a whole lot of big bucks for the overall health system. On top of that, many of SLU’s patients are poor and low income folks from the city who have Medicaid, and SLU offers a lot of charity care.

WashU also does a lot of charity care, but they have the other major revenue streams to make up for it, primarily research. SLU just doesn’t have that kind of infrastructure and I don’t see anything changing in the near future under the current leadership. 

The sad reality for society in general is that hospital systems are primarily profit driven and really only care about their bottom line. If you’re not in the money making business, you’re not going to be able to keep up with the other big hospital networks. I guess the sad reality for SLU is that they’re currently not very good at generating revenue. Maybe it’s because our mission ties us down and we’re focused on helping the sickest and neediest of society, without being overly driven by the profit motive? Not saying that’s a bad thing in a moralistic sense, but it is food for thought, especially when it comes to financial difficulties.....

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5 hours ago, NashvilleBilliken said:

I actually just got notified of this via my daily email from Becker's. Looks like there is a lot more going on here than just an EHR rollout. Agree that the buck stops with Fred on this and we better implement some changes quickly.

 

https://www.beckershospitalreview.com/finance/slu-physician-group-implements-hiring-freeze-after-ehr-rollout.html

Be careful saying this or you’ll get a bad post comment! Pestello is a lifetime academic/sociology professor who is in charge of running a multi-million dollar enterprise. Think really hard and long about that one. Not one Fortune 500 company would ever hire Pestello to run their business. He is in way over his head and has no business as president. Not all the board is bad, I know for a fact that several current board members are not aware of the missteps and poor management on a day to day basis. The chairman needs to go with Pestello, get a credible business minded person as chair, that is young, will challenge/hold president accountable and has vision. Need a president that has gravity, presence, smart, vision and can raise money. Neither guys at top check any of the boxes, sorry. Look at the front page of the paper, the med school, enrollment, law school....blaming Father B arguement has gone stale like whole university under current leadership. Going to keep getting worse if not corrected soon. I don’t care what anyone says, med school is still a disaster across the board and sinking rest of the ship. Just keep watching, I hope it turns around and I’m wrong, but nothing tells me otherwise right now. Sad. 

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