Menifee Valley Medical Center: Gregory R. Padilla, Administrator

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There was a time when Menifee Valley Medical Center (MVMC) in Menifee, Calif., was struggling to improve its patient-satisfaction scores.

“We were probably way in the cellar with our HCAHPS,” Gregory R. Padilla, administrator, said.

Within seven months, however, the 84-bed MVMC, with a catchment area of approximately 150,000 people, staged a remarkable turnaround.

“Now we’re trending up over the 50th percentile in most of the areas,” he said.

Press Ganey, the third party who monitors their surveys, has acknowledged this turnaround. In a letter sent to the leadership team, the organization noted that a significant transformation has been established within the system, one that has laid a solid foundation of culture change for the future.

According to Padilla this culture change involved two strategies—a renewed focus on patient satisfaction and a drive to establish the center as a major competitor in a highly competitive area.

A “can-do” attitude

Padilla has spent a large portion of his career working in health systems across many states. He has learned that the greatest value an executive can bring to an organization is a “can-do” attitude.

From the moment he arrives at an organization, Padilla remarked, “I establish myself as someone who can turn operations around.”

He strives to first, change the culture, transforming its foundation, getting its executive house in order, then moving on to relationships with physicians.

“I have great physician relationships,” Padilla said. “I like working with physicians, and I like working with people. I’m a strategic leader and consider myself a visionary. It is important for me to always be looking at what type of services and new ideas we can implement in the hospital.”

Right now, Physicians for Healthy Hospitals Inc. (PPH), owners of MVMC, is driving the hospital forward to becoming part of an ACO. To achieve this goal, Padilla is working on putting clinics in outside areas and bringing doctors into the building, where he can lease office space to them. His goal is to create Centers of Excellence, especially in the areas the medical center is currently developing, such as bariatric and spine. He believes that being a Center of Excellence will be vital in the new reform environment.

“I think one big part of it is they’re going to be looking at quality of care, and what a better way to do that than to establish yourself as a Center of Excellence,” Padilla observed.

Because MVMC is physician-owned, the executive team is in constant touch with the physicians at monthly meetings. The arrangement enables Padilla to aggressively pursue another one of his goals–building a network of physicians.

In the last year, MVMC has recruited 20 physicians. The primary goal of these efforts is to recruit multi-specialty physicians.

“Healthcare reform has got to include collaboration with a network of physicians, as well as building specialty services in surgery,” Padilla said. “It has a lot of big unknowns, but you’ve just got to put yourself in a position to get ready for that.”

Preparing for the unknowns

To prepare for these unknowns, MVMC has started picking up risk contracts or a per-member-per-month (PMPM) contract, where the hospital agrees to a standard or set monthly payment from patients. It’s then MVMC’s responsibility to case-manage these patients within the system. If a patient’s care is not properly managed, then the cost of that care could be higher than the PM/PM payment, essentially creating a situation where reimbursement does not cover cost for that month.

However, there’s a greater goal at work here, Padilla said. “It doesn’t just mean case managing. It also means keeping the patients in your network.”

Beyond the patient base, vendor relationships are also changing, Padilla added. Hospitals are being more aggressive with their vendors, especially in orthopedics, where organizations are putting some services out to bid, even though they’ve had long-standing relationships with certain vendors.

It’s all about who will give them the best competitive price, Padilla explained, even in areas like surgery. Here, collaborating with the physicians is also very important; you need their buy-in on this strategy.

“I think you’re starting to see this strategy through the United States,” he observed.

Making care about the patients

Also in preparation for the unknowns, MVMC is increasingly focused on falls, restraints, and core measures. Padilla’s board is very involved in patient safety and quality matters, and they’re constantly looking at ways to improve their performance in these areas.

For example, they implemented the use of high-low beds and stringent nursing protocols to reduce the risk of falls. PHH also trends various quality indicators and monitors the quarterly value-based purchasing report because it believes in the future, the healthcare reimbursement system will increase its focus on a system based on pay-for-performance criteria.

-by Pete Fernbaugh

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