Antelope Valley Hospital: Edward Mirzabegian, MHA , Chief Executive Officer

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Antelope Valley Hospital is a $365-million, 420-bed facility that serves 1.2 million people in the greater area surrounding Lancaster, Calif., located about 60 miles north of downtown Los Angeles.

Offering every service except transplants, Antelope Valley hosts the second-busiest emergency room in the state of California. Because of the mountains in the area, it is one of the only hospitals around, making the hospital’s operations busy and expansive.

For example, Antelope Valley delivers nearly 6,000 babies each year, serves as the only trauma center for northern Los Angeles County, runs the EMS system’s base station for about 1500 sq. miles of the county, and hosts a stroke and STEMI center.

Currently, the organization is working on a $42-million modernization and reconstruction of the hospital. This includes the addition of a Cardiovascular Center of Excellence and an upgrade of the imaging department.

Out of the red and into the black

Five years ago, Antelope Valley was fighting to survive. Mismanagement had rendered it almost bankrupt, not just financially, but also with employee morale.

Its financial state was so bad that cutting 50 percent of costs wouldn’t have been enough. As Edward Mirzabegian, MHA, chief executive officer, related, the hospital had to concentrate on creating revenue streams. Mirzabegian, then new to his position, set up a revenue-cycle department and hired a vice president to oversee it. This vice president would report directly to him.

It was a new approach, since revenue typically reports to the chief financial officer. But Mirzabegian felt it was imperative that he involve himself directly in these efforts, giving as much attention to revenue as  he did to quality.

“The most important element for any industry is really the revenue side of it, not the expense side,” he observed. “Right now, revenue cycle is a product line in the forefront of what we do, just like quality. If there’s no revenue, it doesn’t matter how much you cut costs, you won’t survive.”

Mirzabegian and his team rebooted everything about the hospital’s approach to revenue, resulting in almost 600 new steps and initiatives. The hospital changed the way it billed, the way it charged, the way it renewed all of the processes for collection and reimbursement, and it reevaluated all contracts.

Mirzabegian also felt the culture at Antelope Valley needed to focus on becoming more customer-oriented. In fact, he felt the most important piece of the hospital’s recovery playbook was cultivating and nurturing the values they wanted to push within the organization.

“As far as value, we’ve worked very hard to change the culture and how we treat each other,” he said. “And that is a very slow process, even though we have taken big steps forward, but it is really a work in progress and there’s a lot still to be desired.”

A complete turnaround

Since these methods were implemented, Mirzabegian said the hospital has done a complete turnaround and is now $20 million on the positive side. Beyond the action plan he and his board implemented, Mirzabegian credits the teamwork of his staff.

“Overall, everybody pitched in,” he said. “We had the main goal of what to do, and we just worked on that.”

His main challenge now is repairing a decaying infrastructure.

“This is a big challenge for me because it requires a lot of money,” Mirzabegian stated. “With the existing market and the current state of borrowing and financing, it’s really becoming difficult.”

He and his board are also feverishly searching for the right talent to work at Antelope Valley. Because of various factors unique to California, it’s difficult to transplant people from other states, especially when they have other, less expensive options than Antelope Valley.

As Mirzabegian succinctly put it, “Recruiting talent is a big problem here.”

The hospital is prioritizing its investments according to departmental needs and new programs, like the aforementioned cardiovascular center. It is also retooling its surgery product line, making sure the instrumentation and equipment the physicians use is up-to-date. One recent addition was the da Vinci robotic surgical system.

And even though producing revenue has been a priority over the last five years, Mirzabegian is quick to emphasize that patient safety is always at the forefront of everything they do.

Along with 12 other hospitals on the West Coast, Antelope Valley is working with the Institute for Healthcare Improvement (IHI) to focus on  “Patient- and Family-Centered Care.” In the past, Mirzabegian explained, the focus has been on patients, but patient- and family-centered care is geared to bringing families and patients together in the delivery of care.

“Most of the complaints we have received come from the families, not the patients. Families are often the ones filling out the surveys and answering the tough questions, not the patient. Everything is going to be geared toward communicating with the family members, as well as the patients. So it’s a new era with our patients, as far as the safety and quality of care is concerned.”

A hospital on the map and in the game

In spite of the hospital’s turnaround, Mirzabegian is not a rose-tinted optimist. He expressed great frustration with many of the current healthcare mandates that he said are “total obstacles to everything that we want to do as an industry.”

“The challenges we are facing, from the Affordable Care Act, ACO requirements, and healthcare reform, are really making it hard to run a hospital and provide the right care,” he explained. “Do we need to change? Absolutely. Healthcare has to change in this country, because the way we’re going, I doubt anyone will be able to afford it in the next 10 to 20 years. So things have to change. But the way the existing administration is proceeding is not the way to go.”

Nevertheless, he said Antelope Valley is competitive and still able to make a difference within its community.

“We are on the map and we are a player within the healthcare industry here, and we want to make sure that people know that our quality of care is one of the best in the Los Angeles area. We want to be the hospital of choice for people within our market.”

-by Pete Fernbaugh

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