John Marzinzik, CEO of Frisbie Memorial Hospital. Photo by Matthew J. Mowry
Facing one of the state’s highest levels of uncompensated care and emerging from a highly publicized two-year battle with Anthem Blue Cross Blue Shield over being excluded from the insurer’s federal health exchange plans in NH, Frisbie Memorial Hospital in Rochester is ready to move forward with a new leader at the helm.
Former Frisbie president Al Felgar waged a very public battle, demanding the hospital be included in the Anthem network with nine other hospitals. But as that battle appeared to head toward resolution, Felgar retired after more than 20 years as CEO and John Marzinzik, who had been with the hospital since 1993, took over in January 2015.
That change brought a new energy to the hospital. According to Marzinzik, Frisbie is positioning itself for growth by adapting to the looming needs of the community. He says Felgar had a good vision but that it’s appropriate to change that moving forward.
Preparing for the Silver Tsunami
When the hospital’s board approached Marzinzik about leading the hospital, they asked him what direction he would take the institution. “I saw a tsunami of geriatric care coming our way. The first of January 2011, 10,000 Americans turned 65 years old,” he says, adding that 10,000 boomers a day are turning 65 between through 2018. “Of those, 30 percent will have some sort of dementia.”
Among his priorities is to place Frisbie in a position of leadership in geriatric care. He points out there are only 50 beds in the entire state dedicated to managing geriatric psychiatric issues, and Frisbie has 20 of them, half of which were added only a few months ago. Prior to adding the beds, the hospital had a waiting list at any given time of 10 to 12 patients, says Joseph Shields, senior vice president. Now the hospital regularly has its beds filled and will continue to ramp up the number of geriatric patients it treats.
The hospital is experienced in this area, having opened the first geriatric psychiatric unit in New England in 1984. Now there is stiff competition for professionals in this area (only about 50 geriatric psychiatric resident doctors nationally graduate each year), Shields says. So Frisbie is expanding how it accomplishes its goals, including working with nursing homes to treat patients where they are. Frisbie is also developing an outpatient day program for those suffering from dementia.
“We’re not dealing with the issue. We’re embracing it,” Marzinzik says. “Our community will have these services.”
Courting Surgery Patients
Frisbie is also following trends in outpatient care, creating its own outpatient surgery center and lab to compete with lower cost options in the area, even though those services cut into hospital revenue.
To stave off a loss of surgical patients, Frisbie partnered with a group of physicians to invest $1.5 million (97 percent of which was paid for by Frisbie) to build Skyhaven Surgery Center, a 16,000-square-foot ambulatory surgical center in Rochester, which is slated to start treating patients this month. Profits are split with 83 percent going to Frisbie and 17 percent to physicians, Shields says.
Another initiative the hospital has undertaken to keep patient dollars from flowing out of the city for lower-cost services was the creation of Granite State Lab in 2013. This lab competes with low-cost independent labs that were drawing business away. It also allows lab results to be entered directly into electronic records. “We’ll be able to keep heath care information in our community,” Marzinzik says.
Such low-cost endeavors cut into the hospital’s revenue, but it’s what insurance companies and patients are demanding, Shields says. Patients will be able to pay 40 to 50 percent less for procedures at the new ambulatory surgical center than they would at the hospital, which has significant overhead, Shields says, adding the hospital is looking to add other services to make up for lost revenue.
New Partnerships
Another way Frisbie is ensuring its future viability is through partnerships. “Frisbie, particularly over the past year, looks to partner with others in the community,” Marzinzik says. The hospital is in discussions with Leahy Clinic in Burlington, Mass. to strengthen Frisbie’s oncology program.
In October, Frisbie, with Dartmouth-Hitchcock in Lebanon, Elliot Health System in Manchester, and Harvard Pilgrim Health Care, are launching a new company—Benevera Health—that aims to improve the quality of health care while reducing costs. To do so, it will bring together clinical, financial and operational data from across the partner institutions and provide actionable analytics for clinicians to provide better, more efficient care, including preventative care. Over the next three to four years, this will alter reimbursement procedures, basing them more on patient outcomes and use, Shields says. “It behooves us to learn to better manage the health of those,” with chronic conditions, he says.
Benevera Health is jointly owned by all the partners, giving the hospitals a say in the design of Harvard Pilgrim’s insurance products and strategy in NH. Harvard Pilgrim estimates premiums will be 4 percent lower in 2016 than they would be without this partnership.
Benevera Health, which launched Jan. 1, will provide physicians with data to help improve patient treatment and by hiring about 40 health care professionals, most of whom will work at the partner hospitals, helping patients better manage their health care.
“We are going to be able to significantly improve the quality of care,” Marzinzik says. Between the three hospitals, they will be able to analyze data of 80,000 patients, do a predictive analysis of patients most at risk of chronic diseases and assign care coordinators to work with patients to mitigate those risks, Marzinzik says.
He notes 5 percent of Harvard Pilgrim’s patients account for 67 percent of the care provided, and this approach should slash costs from chronic diseases while also improving patient outcomes.
To effectively contribute to the data pool, Frisbie is investing $8 million in a data system that will be used across its system, which it is financing.
Frisbie is also looking beyond the health care community. The heroin and opioid epidemic sweeping across the state has not left Rochester unscathed, and Frisbie is at the forefront. The hospital partnered with the Rochester Police Department to make it the first department in the state certified and trained to carry and use Narcan, a drug used to revive overdose patients.
“Did we get a lot of negative push back? Yes. Did we save lives? Yes,” Marzinzik says.
Strengthening Community Ties
Frisbie is seeking different ways to strengthen its ties in the community. Marzinzik says the hospital is examining using its ambulance service to send paramedics during downtimes to conduct home visits for the highest risk patients to make sure they are meeting their medical needs.
Frisbie is working with Spaulding High School to develop a medical mentoring program, which includes job shadowing, to teach students about the job opportunities at the hospital and the skills required for those positions.
Such efforts seem to be working as the hospital is seeing its financial standing improve and garners accolades. Frisbie’s Center for Wound Care is the only such center in the state to be nationally recognized for excellence; Consumer Reports ranked Frisbie as the top hospital in NH and third in New England for patient safety and respect, and in 2014 Frisbie made Harvard Pilgrim’s Quality Honor Roll for a fourth consecutive year. While revenue has remained relatively steady—the hospital generated revenue of $124.6 million in FY2014, down from FY 2013 ($125.5 million) but up from FY 2012 (122.5 million)—utilization between FY 2014 and FY 2015 is up 7.4 percent for inpatient care and almost 3 percent for outpatient care, according to Shields. Yet uncompensated care remains high for the hospital at $7.5 million in FY 2014.
Shields says while the hospital is making several investments, many will pay off with either greater efficiencies or increased revenue down the road. The investment in the unified data system will help the hospital better manage its data, which will in turn help it to better manage patients’ health and maximize reimbursements from commercial insurers and government programs. The geriatric program is a potential revenue source as people ages 65 and over are the fastest growing patient population. Investing in behavioral health and drug services will cut down on costly emergency room visits. “Last year, we spent $147,000 on security to watch psychiatric patients to make sure they did not harm themselves or others,” while they waited days or weeks in the emergency room until space opened at an appropriate treatment facility, Shields says.
Marzinzik is confident such investments will solidify the hospital’s future. “We’re growing. Our volumes are going up,” Marzinzik says. “I am humbled the board allowed me to be president of the hospital. There’s a great deal of pride in this place.”
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