Asheville Specialty Hospital: Bob Desotelle, Chief Executive Officer

by HCE Exchange on March 8, 2012

Historically, long-term care hospitals have struggled to articulate their value and position in the healthcare market. Recently, these facilities, which already advocate high-touch over high-tech care, have faced even steeper reimbursement cuts and regulatory limitations. But long-term care facilities play an important role in healthcare and are steadily becoming more involved in reporting quality and outcomes to maintain their place in patient care.

Asheville Specialty Hospital is one such facility. It is a 34-bed acute-care hospital and part of the larger Mission Health System based in the mountain region of Asheville, N.C. A joint venture between Mission Health System and Community CarePartners, Asheville is certified by Medicare as a long-term care hospital and runs an average census of about 25 patients.

Focusing on quality and outcomes

One criticism of long-term care facilities has been a lack of oversight or reporting on quality measures that most hospitals have been following for years. This is rapidly changing, and Asheville Specialty Hospital participates in quality benchmarks along with comparable hospitals. Although data is limited for long-term care facilities, Asheville reports quality measures with Thomson-Reuters. This allows the organization to compare benchmarks with other similar hospitals.

“Our biggest focus is on quality,” said Chief Executive Officer Bob Desotelle. “We have excellent outcomes, good scores on employee and patient satisfaction, and a high percentage of our patients go home. We have a strong clinical program.”

Sending patients home is a big accomplishment for Asheville. Usually patients come to the facility after a catastrophic medical event.

“We help patients adapt to life-changing events,” Desotelle said. “In some cases, things aren’t going to get better, and those are difficult conversations to have.  But it is rewarding to work with the patients in our hospital and to see those miracle patients who recover and walk out of here.”

Asheville has made great strides in improving quality and patient safety through a number of measures. Infection control has been one area of progress for the hospital. After implementing a program to prevent urinary-tract infections, the hospital went six months with no UTIs.

By being part of Mission Health System, Asheville Specialty Hospital is able to implement an electronic medical record, follow national patient-safety guidelines that are used by the system, and follow guidelines for ventilator bundles and infection-control bundles. Asheville has also implemented Lean quality initiatives. Bedside medication administration is a future goal, and barcoding has shown great improvement in patient and nursing satisfaction. Patient falls have also gone down because nurses are more often in the room with patients.

Another major improvement has been in wound care. About a year ago, the hospital began using a protein-rich plasma product called Autologel by Cytomedix. Desotelle said the patient outcomes have been “phenomenal” with a 34-percent cost savings over traditional wound-care therapies. The pilot project at Asheville has been so successful that Mission Hospital began using the product as well.

“We are always trying to ensure we are doing things that improve the care for our patients, while balancing costs,” Desotelle said.

Adjusting to a changing environment

Patient care is always top priority in any healthcare facility, and Desotelle keeps clinical excellence as his primary personal value. Having been a nurse before moving into administration, Desotelle brings a certain level of compassion in working with the medical staff and in implementing administrative decisions that affect patient care.

He has been a travelling nurse with experience in many different markets, and with today’s economy, he believes it is important to always ask, “Why are we doing this?” He said sometimes he may receive resistance to the question, but with strict regulations and lower profit margins imposed on the industry, all ways of delivering care must be evaluated.

Asheville operates on about a three-percent margin. Medicare has instituted rules stating that the hospital can only accept up to 75 percent of its patients from one hospital. In Asheville, this regulation is extremely cumbersome. Asheville Specialty Hospital is just down the street from a 700-bed tertiary referral center, but if it accepts more than 75 percent of its patients from that hospital, it can get penalized.

“The regulatory environment is a big burden for our industry right now,” Desotelle said. “As an industry, we haven’t been good about stating our benefits. But more research is available now showing that we can save Medicare money. Our program incorporates rehabilitation and acute-care concepts in a way that saves money.”

As with any facility, Asheville is looking at ways to improve costs and manage patient care. It has brought in a hospitalist group to develop consistent patient management and to effectively manage length of stay. Looking at discharge procedures is also a concern.

“We have higher acuity discharges, and what nursing homes will accept varies from community to community,” Desotelle said. “We have begun involving palliative-care programs, and improving communication with patients and their families to help them make an informed decision about their care.”

“We have challenging times ahead of us, and we are all struggling with the realities,” he added. “We have to find a better way to provide care at a lower cost, while maintaining quality along with employee and physician satisfaction. We have to change the practice and look at all options to get better outcomes less expensively.”

-by Patricia Chaney

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