Randy McCleese, vice president and CIO of St. Claire Regional Medical Center in Morehead, Kentucky, has spent 18 years as a senior IT leader at that 159-bed community hospital, which serves patients in an area just east of Lexington, in the foothills of the Appalachian Mountains. With a staff of just 19, McCleese is facing intense human resource shortages, as he and his team work forward not only to fulfill the requirements of Stage 2 of meaningful use under the HITECH (Health Information Technology for Economic and Clinical Health) Act, but also the requirements associated with participation in a Medicare Shared Savings Program (MSSP) accountable care organization (ACO). St. Claire Regional Medical Center is participating in the Good Health ACO, created by the Richmond, Virginia-based Bon Secours Health System; it is the only organization not owned by Bon Secours that is a participant in that ACO.
Given all that, plus the obligations facing hospitals under three mandatory programs created by the Affordable Care Act (ACA)—the value-based purchasing program, healthcare-acquired conditions reduction program, and avoidable readmissions reduction program—McCleese finds himself faced with a welter of demands and imperatives these days. In that regard, he brings a much-needed perspective—that of the CIO of a smaller, rural, independent hospital—to his role as the new chairman of the board of the Ann Arbor, Mich.-based College of Healthcare Information Management Executives (CHIME).
McCleese spoke of the challenges and opportunities he faces in his CIO position, as well as the year ahead facing CHIME as an association, during the CHIME-HIMSS Forum, being held Feb. 23 at the Hyatt Regency Orlando. Below are excerpts from his interview with HCI Editor-in-Chief Mark Hagland.
Congratulations on your elevation to the role of chairman of the board of CHIME. Tell me about what this means for you?
For me to be chair of the board—it’s just an extreme honor to know that my colleagues, my counterparts around the country, have expressed that much confidence in me; and it’s very gratifying to me that CHIME has chosen a board chair from a smaller hospital, to help lead the organization.
How does this period of transformative change look to you as the CIO of a smaller hospital?
It’s one of the more difficult, yet exciting times. We realize as an industry and in the government that we need information technology to make us more efficient and effective and provide better quality of care to patients. The change to electronic care from being paper-based has been a huge mountain to climb, and in order to climb that mountain, we have to make so many things align, including changing workflows, changing people’s habits, and teaching people how to use technology. And the larger hospitals have had a head start on that for years. And even though we in smaller hospitals realized that it was a benefit to make the shift, we just lacked both the financial, and especially the human resources, to do it. The government’s requiring us to go to electronic records has essentially caused us to do it. I’m pretty comfortable in saying that if the federal government had not required us to transition to electronic records, most of us would have waited for years to make the shift, because of the lack of financial and human resources to do so.
What would your advice be to your fellow CIOs in smaller, rural, and standalone hospitals?
There are a few who may still have their heads in the sand. But to me, what they need to be doing is to involve in some manner—and CHIME is one of the best ways to do that—but involve themselves in some manner to understand the changes coming, including how to provide education to the other c-suite members, and down to management—making sure that everybody understands that [the healthcare policy and reimbursement landscape] is changing, and if we’re not on board with it, we won’t be on board with anything for very long.
Looking at three of the larger mandatory programs under healthcare reform—value-based purchasing, healthcare-acquired conditions reduction, and avoidable readmissions reduction, all of which have very big IT and data implications—how how do you view the obligations for CIOs that are emanating out of the requirements of those programs?
All three, especially the first and third, are programs that people need IT for. They need to do the analytic work, especially in value-based purchasing, to do the analysis needed for success. With readmissions, it’s getting the systems to operate well enough to identify patients at risk and follow them—making sure that patient doesn’t come back for those same things. We’re involved in an MSSP ACO, and we’re seeing those patients and seeing how we have to manage their care. And having those folks out there to really manage their care management. Being part of the Good Health MSSP with Bon Secours, which took effect Jan. 1, 2013—and by the way, we’re the only non-Bon Secours hospital—is a tremendous amount of work.
Would you agree that accountable care, in the broadest sense of the term, is the future of healthcare?
Yes, I agree.
What’s particularly interesting for me about accountable care development is that it’s taking place at a time when the healthcare industry in this country is undergoing two revolutions at once—its own version of the Industrial Revolution, involving process change and standardization of processes and outcomes—and the Information Age Revolution. That makes everything much harder.
Yes, and it’s important for the CEO and CMO in a patient care organization to see how the data works. Are we using the same data from the same sources, and why is that one cardiologist out there as an outlier? It’s up to information technology and the CIO, to make sure it’s valid data displayed validly. And then to make sure the processes are changed to bring that clinician outlier more into line, that’s a team thing. The physicians are saying, you’re requiring me to provide standardized medicine, and you’re not allowing me to personalize my medical practice. And yes, in a sense, that’s right, we’re moving towards standardization of practice. And frankly, we’re doing that in our ACO.
What have been the biggest challenges so far?
The amount of data we’re getting from CMS [the federal Centers for Medicare & Medicaid Services], and then the amount of data we’re having to put together for the Bon Secours group in order to provide CMS with what it needs.
It’s keeping you working long hours, I’d presume?
Yes, it is. I have a total 19 FTEs; that’s not many, and I’ve had to dedicate one and a half of those to this ACO, so that’s really stretched us.
What do you hope CHIME will be able to do for organizations like yours, in the next year?
We from the board standpoint, and myself as chair, we’re working with the federal agencies as much as we can, to optimize things for our members. We feel it’s difficult to meet some of the meaningful use criteria. It’s like an all-or-nothing situation, where we’re able to meet 90 percent of the requirements, but we’re penalized as though we’ve met none. And I’ve talked to CIOs at other hospitals, and if they’re still finishing up the stage 1 requireme3nts, like putting in the patient portal—and we have to have the patient involvement.
We can teach patients and teach patients how to get on a computer and look at records, and unless patients have the desire to do that, we can’t force them to do that. And it’s moving up in Stage 2 that you have verify that 10 percent of patients have to view their records and download them. And in our part of the world, that’s tough, a lot of people aren’t even using computers. So we may have to not only teach them, but also provide the access. And that’s an expense that goes beyond patient care. And that’s a generational thing.
Yes, you’re asking 10 percent of your patients over 65 to do that—to download their patient information digitally.
Yes, and to give you a personal example of that challenge, I have a brother who’s a maintenance worker in a school district, and he has no computer, and doesn’t like to use computers. So he’d be a typical “problem” patient in that regard, and we have many in the region where I work.
So the next few years will be very intense, meeting all the requirements from these various programs, correct? For example, our magazine pointed out nearly two years ago that Medicare cuts coming out of the three mandatory ACA programs I mentioned above, could total 9 percent of Medicare revenues for the worst-performing hospitals. For hospitals with 50 percent of their revenues coming from Medicare, and surviving on 1- and 2-percent margins, that could be devastating.
Yes, that’s right. The reimbursement cuts coming out of meaningful use and healthcare reform, together, will put a lot of caregivers out of business. And you’re right about hospital margins—we’re sometimes getting a 1-percent margin, and sometimes we’re zero. And so if we were to get cuts from those programs, it will put some hospitals and especially some doctors, out of business; some doctors may go to a cash-only business. And that may include some of our brightest physicians. And that concerns me. And it concerns me that cuts at that level could put some community hospitals out of business, or force them to merge or be acquired. The environment totally changes if you merge with someone else. We’ve always been an independent, Catholic, faith-based hospital, that has the community’s best interest at heart.
So to survive in the emerging healthcare, we’re going to have to be totally automated, and that will require CIO and IT leadership, right?
Yes, and at the CEO and the board level, they need to think about technology anytime they’re thinking of getting into anything, and how it can make us more efficient and effective in what we’re doing. And I don’t think I’m alone among CIOs, especially in community hospitals, in saying that decisions are made before we think about things in terms of an IT standpoint. And when mergers and acquisitions happen, that can be an afterthought.
Are you excited to be in this board chair role at CHIME in the next year?
I’m both excited and honored to be doing what I’m doing with CHIME. From the hospital standpoint, I’ve gotten great support to do what I have to do as the CHIME chair. It’s very exciting to be involved with the folks making some of the regulations, and to get my two cents’ worth in.