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KVH Chief Ancillary Officer and Roslyn community member Rhonda Holden named to new Federal Advisory Committee

HealthNews · Dec 15, 2022 ·

On Tuesday, December 13 the Biden-Harris Administration announced that local resident Rhonda Holden, RN, BSN, MSN was one of 17 individuals throughout the country selected to join the Ground Ambulance and Patient Billing (GAPB) Advisory Committee. This new federal advisory committee was created in November of 2021 to improve the disclosure of charges and fees for ground ambulance services and to better inform consumers of insurance options for such services and protect consumers from balance billing.

Ms. Holden will provide the committee with insight into the unique needs of rural communities that rely on ground ambulance services, not only to respond to accidents and emergencies but also to transport patients long distances to a higher level of care. “I believe we can work together to revise the payment structure for ground ambulance transports which will ultimately alleviate burdensome financial challenges for consumers. Financial concerns should not be a barrier to access life-saving care for any American,” states Holden.

Rhonda’s career as a registered nurse has been spent largely serving rural communities. She is a long time resident of Roslyn with an in-depth experience in advisory roles. She currently serves as the Chief Ancillary Officer at Kittitas Valley Healthcare (KVH) and is the Director of Strategic Initiatives for Kittitas County Public Hospital District #2, which operates Medic One, the only advanced life support (ALS) ambulance service in Upper County.

“Ms. Holden is well qualified to articulate the unique challenges that rural ground ambulance consumers and providers experience and will represent the rural perspective,” stated KVH Commissioner Robert Davis in her nomination letter. Ms. Holden’s nomination was supported by Kittitas County Hospital District 1 and 2’s Boards of Commissioners, the Legislators of Washington State’s 13th District, the Washington State Hospital Association, the Washington State EMS and Trauma Steering Committee, the Washington State Emergency Cardiac and Stroke Technical Advisory Committee and the American Hospital Association’s Rural Health Services.

For more information on the Ground Ambulance and Patient Billing Advisory Committee appointments see Members of New Federal Advisory Committee Named to Help Improve Ground Ambulance Disclosure and Billing Practices for Consumers | CMS and 2022-27263.pdf (federalregister.gov).

For information on the GAPB committee and charter see Advisory Committee on Ground Ambulance and Patient Billing (GAPB) | CMS

For inquiries on the GAPB please contact press@cms.hhs.gov

Behind the Scenes: Quality Management

HealthNews · Dec 18, 2019 ·

For the final installment of the series, we sat down with some of the Quality team to learn about what they do. Unlike other ‘Behind-the-Scenes’ interviews, this one had only one guiding question: “How does your work support the mission of KVH to provide quality patient care?”

It seems like you don’t have any redundancies in your staffing, right? Everybody has a different role.

Mandee: Carissa and Kimber are both process improvement facilitators. That is one thing that is very similar for all of us – we all facilitate improvement, whether it’s a surgical site infection, or a needle stick, or sepsis care – figuring out what’s going on with the process and how we could improve it.

How does the work that you do impact patient care?

Julie: One example is the lack of surgical site infections. We work hard to maintain a standard, so that there’s less of a chance for surgical site infections.

How does that happen?

M: Julie doesn’t directly go and clean all the rooms and check all the labs. But what she’s doing every day is looking at our stats, our data, and seeing how we’re doing and where we need to improve, working with departments like housekeeping, sterile processing, surgery, med/surg, all the different areas. She talks with Home Health, too, helping them understand best practices for protecting the environment, keeping it clean, and also for patients, and for protecting themselves. We support the rest of the organization, helping address any barriers to providing reliable care or processes, even in billing, removing those barriers and identifying ways to make the work more effective.

The most basic example would be employee flu shots, right? So, yes, it’s caring for the staff, but it’s also helping ensure that when the patient and the community come into the facilities –

J: It’s mostly caring for the patients.

That may be something people don’t realize, that KVH staff are vaccinated against the flu primarily for the patients’ protection. They don’t necessarily know all the work that’s going on to make it happen, but that kind of thing has a direct impact.

M: It’s when things haven’t gone well that it gets to Brandee and Linda, when we’re seeing incidents in the incident reporting system. It’s looking at that and saying, “Is this a one-off, or is this something bigger that we need to do improvement with teams and help them make sure this doesn’t happen again?”

Brandee works on the falls team, too. They do root cause analysis on every fall and say, “What could we do differently?” So the parking lot repairs are the work of the falls team saying, “These curbs, this isn’t working. We’ve had this many falls. The pothole in the middle there, that’s a problem, we need to address it.”

And in some sense you are getting, even if it’s in writing, direct communication from patients and the community, as well.

Brandee: Another piece of that is the service recovery program. I tell staff “It’s a way that you can make it right, right now.” It’s an opportunity to show a patient that you care, that you’re not just going to blow it off to somebody else, that you’re trying to do the best you can to make it right for them.

Because quality patient care is mostly about the actual physical care, but it also involves satisfaction, and feeling that you’ve been heard, and that kind of thing.

M: A huge part of what we do is empower employees to speak up, try and make it right. Incident reporting is a huge part of it, as are SAFE boards, or Linda as a compliance officer hearing concerns.

I was just looking at some of Amy’s work. We do measure a ton of things in here, but we even measure what we measure. Amy had 99 different report requests this year that she’s worked on and that has helped staff from, for example, the clinics, with a list of their patients who were recently in the emergency department, so they can follow up with those patients and make sure they’re getting appropriate care. That’s made a huge difference for them because they didn’t have a system to notify them. A lot of what Amy does is build reports for people that make their job easier every day.

You can boil a year’s worth of data down into a report that you can wrap your brain around. It makes a difference.

M: We report a lot of data externally because it’s either the law or we won’t get paid if we don’t do it – things like surgical site infections, sepsis and stroke data. We don’t get our stroke designation if we don’t have data reported to Get with the Guidelines. We do this so that our staff can take care of patients. I don’t want the ER nurse having to worry about abstracting charts and putting that into Get with the Guidelines so that we can have that stroke designation or get paid from CMS.

Linda: Part of the process with patients, when it actually becomes a grievance and they’re voicing what it felt like to them, their perception of that care experience – that information gets shared with the department leaders and then with staff, who are not always aware until that patient voice speaks up that the patient doesn’t know you’re doing all these other things in the background supporting their care at the time. You know, at the time they can only see what’s within their own vision.

Staff are the ones who can really look at their processes to care for a patient and if there’s anything that they could do differently that would better have met the needs of that patient at that time. And maybe everything was done, and met the standard of care. But maybe it was just more communication that needed to occur to help the patient be aware, “This is why we’re doing this. This is why we may be waiting for a while.”

M: We try to bring that patient perspective back to staff. For KVH employees, it’s our job, every day, and we get very used to it. It’s very routine to us. But for a patient it could be the worst day of their life. And so it’s bringing that perspective back to folks that they may have lost touch with.

B: Another thing Linda does is family meetings. In certain cases, grievances that we get, we actually will bring the patient and their family in and we’ll do timelines and everything, and they have the opportunity to just really see how everything was over the period of time during their stay. And then they can really have a good conversation about why decisions were made, and it’s just a different perspective.

L: Some of the patients actually participate in process improvements, like updating educational materials or evaluating processes and things like that.

M: We, especially Linda, also help support our staff and the organization when someone is behaving inappropriately by being abusive, seeking help to stop that, legally if we have to. We also have resources to help with lawsuits, even the ones that aren’t against KVH, such as when emergency and surgical staff are subpoenaed to testify in cases, which can be scary.

We help support strategic initiatives too, like the work we’re doing with chronic care management in the clinics. If we just ask staff to pile on this work, and figure out how to navigate all these requirements and milestones that these new programs are asking us to do, I think that would be overwhelming. I don’t think we’d be able to do it. But process improvement helps break the whole thing down, makes the work manageable, and ensures the right people are involved.

That’s a huge part of what Carissa and Kimber do. It means we’ve been able to implement chronic care management for our patients. That’s a real thing that’s happening with patients in the clinics. They’re improving upon the piece of behavioral health that we have up in Cle Elum, expanding that program, seeing where we could take it further, getting patients in for annual wellness visits, asking how can we make sure we’re good at doing more of that preventative work.

I’m excited about a lot of the work we’ve been able to achieve. We’re not the ones providing care, but we’re helping so those who are can get that work done.

What ways do you celebrate your hard work and help each other out when things are tough? Why do you keep coming back to work every day, besides the paycheck?

Anna: Because we like each other. We’re a close knit group, like a family.

B: I’ve worked in a lot of different departments. This one is unique in the relationships we have with each other and the way we work.

M: One of the ways we recognize each other is in our daily huddle meetings. I also meet one-on-one with each of them every week. Part of that is to acknowledge the good work they’re doing. Everyone functions pretty independently. They really are the experts. Recognizing that every week, and having the autonomy to be the expert in your area, helps us feel like it’s not drudgery.

L: And sometimes we’re just pulling everyone who has available time to shift to supporting whatever things are going on.

A: Everybody just jumps in and helps.

B: I know if I am swamped with care and service, I have people that can help me with that.

To me that’s a sign of a healthy department. I know sometimes I’ll be too proud, “I’ll get all this done if it kills me,” and then it’s not done well.

M: Well, that’s taken work. We have given each other crap repeatedly about asking for help.

It seems like you guys are getting there. That’s great.

B: We’re holding each other accountable, too.

M: You were asking about how we celebrate the work. The SAFE Catch awards is my favorite part of my job. Brandee has a big part in organizing that, and everybody’s nominated somebody at some point. Just sharing those stories is really inspiring to me.

Those people are part of your team that you’re celebrating. They had that ‘Quality’ mindset and did something that you’re now publicly recognizing.

M: Brandee went to Materials Management yesterday to talk to them about their award and they invited her to their holiday gathering. We have a great team here, but the relationships we have with people outside of our department are really rewarding, too. The really smart, funny, caring people that we get to interact with every day.

It’s a great place to work in general.

B: And I think to like people are more and more comfortable coming to us with questions, even if it’s just for our 2 cents, like it’s not even our monkeys, but they’re saying, “Okay, I’ve got this thing. I’m not really sure how to deal with it.” They know we may have some good advice. People know we’re a resource for them.

Behind the Scenes: The Foundation at KVH

HealthNews · Nov 22, 2019 ·

We sat down with Laura Bobovski, Foundation Assistant, and Donna Walker, Foundation Board of Directors, to learn more about the work of the Foundation in supporting Kittitas Valley Healthcare.

What’s the purpose of the Foundation?

L: We’re a charitable organization that works to support KVH and its role in providing healthcare in the community.

How does the Foundation interact with the community?

D: Well, I’m fairly new, but as people realize that I’m on the Foundation board, I get questions. So we have one-on-one in the community, where people have questions about what’s going on at the hospital.

L: We engage the community through various fundraising events such as the Gobble Wobble 5K for Wellness, the Tough Enough to Wear Pink campaign for breast cancer services, our annual Gala which targets a specific need at KVH to fund, and our annual appeal mailing each fall. A lot of the interaction is through ambassadors, our board members, who do outreach to community groups and citizens about the benefits of supporting healthcare in the valley.

What is your role within the Foundation?

L: I act as a liaison between the board of the Foundation and the hospital. I’m here to assist the board with their goals of fundraising, donations, and events in support of KVH.

D: I’m still figuring my role. But right now, Tough Enough to Wear Pink is my event. I volunteered for several years prior to being on the Foundation board. It’s a year round commitment by the time we do all the planning and find merchandise that we’re going to sell.

Who’s going to be driving the spring gala?

L: There’s a committee overseeing the planning of the gala, but it takes all of the board members to successfully carry out such a large event.

What’s the structure of the Foundation board?

L: Jim Daly is president. Bill Boyum is vice president. Jerry Grebb is finance officer and Cindy Smith is secretary. They’re the executives. It’s a 2-year appointment.

What are the challenges working with/in the Foundation?

L: Educating the community as to what the Foundation is and that we are separate from KVH. Our board of directors oversee the nonprofit charity side of the Foundation and the Board of Commissioners oversee the hospital. I think some people get them confused. There’s a clear and separate division of the hospital and the Foundation with two separate managing arms.

Any challenges that you can think of? You keep saying you’re new. So there’s probably a bit of a learning curve challenge.

D: Laura’s position has changed. It’s been redefined. I think it’s a challenge for us to realize there is more on our shoulders, more of a responsibility to get things done. And for me as a new member, understanding the finances has been difficult.

L: And there is a big responsibility by the Foundation to honor the donations given, exactly…

Apply them in the spirit they were intended.

L: Yes. And to make sure, if somebody gives to hospice, it’s got to go to hospice. We need to honor the intentions of the donor as best as we can. People trust us with their wishes. Often, they donate in memory of a loved one.

Seems like these gifts have their own emotion and history and passion. It’s not just a donation.

L: Exactly. We get a lot coming through hospice in honor of a loved one. This afternoon, I’ve got to return a call from a lady who wants to give in honor of her recently departed friends. So there’s a lot of weight behind that to make sure it’s being used properly.

This work can be very emotional. You know, somebody passes and you get phone calls from the community members wanting to give on their behalf. It’s very touching.

It gives you a good view of the community.

L: I think that’s why a lot of our board members step up and work tirelessly throughout the year, particularly in the case of Tough Enough to Wear Pink. I mean, you’re dealing with breast cancer survivors. A lot of them have lost people in the community, and they’re all stepping forward. When we were selling things at Rodeo, people were coming up and saying, “I lost my sister…” People are coming through the doors in the rodeo spirit, but they’re also sharing their losses with you and it’s just – it’s gut wrenching, sometimes. One man gave us $100 out of his pocket in honor of somebody. It was powerful.

It wasn’t about the tax deduction. He was just giving.

L: No, he didn’t want a T shirt. He didn’t want a hat. He just saw that it was Tough Enough to Wear Pink and gave $100 on his way in, in honor of somebody that he loved, and that – that takes a lot on his behalf. To be standing there receiving that gift is very, very touching.

D: I think for me personally, I’ve done a lot of volunteering locally in different capacities, but then I thought carefully about how I could best serve the larger community. That’s why I’ve landed at KVH.

What are the rewards? Why are you serving in this role?

L: I think a lot of the board members would say they’ve had personal experience, they’ve had personal loss, and that a hospital is very important to the entire community. We have one in this county and we’re very lucky to have it.

Anything surprising or unexpected that you’ve learned while you’ve been serving the Foundation?

D: In my first couple of meetings, I was intrigued by the people on the Foundation board with an extremely wide variety of expertise. They bring a lot to the board and take it very seriously.

L: I was surprised by how knowledgeable the board is. Some of our board members go way back and personally know a lot of community members and their histories. “They’ve moved and aren’t at this address.” “Their spouse died. We need to reach out to them.” It’s the personal connections that the board has with the community that has really blown me away.

How does the Foundation support the KVH mission to provide quality patient care?

D: I know how seriously the Foundation members weigh the options for using funds raised. I mean, there are lively discussions about how to best use those funds to provide better healthcare for patients at KVH.

L: We take a lot of input from the hospital itself in terms of what they need. What we can do to support KVH. So, there’s a lot of input, not just from administration but from department heads. We like to hear from them and know what they are doing, and what can we do to support them.

If someone wants to make a donation, but they want to know more about the options as far as where money could go or what it would do, what would you recommend?

L: Call the Foundation office so that we can discuss their intentions or talk with a board member. More information can be found online at the KVH website.

Behind the Scenes: Food & Nutrition Services

HealthNews · Nov 11, 2019 ·

We sat down with Certified Diet Aides Diane Kirkham and Stephanie Hummel to learn more about the team that feeds hospital patients, families, staff, and even some community member “regulars” at the KVH Café.

As part of the hospital, the café’s open every day of the year. So how does that work? I’m assuming the kitchen is open quite a bit more than the café.

S: It’s open from 6:00 AM to 6:30 PM. And then we have our meal times, breakfast, lunch, dinner, and in between that we’re –

D: Getting ready for breakfast, lunch or dinner, for that day or the next day.

It’s interesting to see how when you bring new people on, even people that are still fairly new are involved in training the new employees.

S: Usually, they start out doing afternoons. Diane and I usually work mornings, but then when they get into doing patients than we do train them. That’s kind of our thing.

D: That’s why we were hired. Patient care. We didn’t have a cafeteria to speak of.

S: We did, but it was very minimal. When we started, there was no breakfast program.

D: You put out a toast tray and some oatmeal and they served themselves.

S: It has grown leaps and bounds. When I started, we had a four-foot salad bar, and maybe five toppings for the green salad.

D: It was pushed up against the wall.

S: We used to have to do the cash register and serve – we did both, and now it’s all separate.

D: That was interesting. We had meal tickets and you had to do the math in your head, whatever they bought. You were marking off the amount and then handing it back –

Sort of like a punch card.

S: Yeah, exactly. That’s how we started. So it’s come a long ways. A long, long ways.

Of all the things you do here, what do you enjoy most?

S: I love details, so I like the two jobs that I do right now. I like to problem solve.

D: She’s very good at putting our menus together.

S: I’m good at organizing. I want it just-so. Diane’s the same way, but she’s chill and laid back. She’s very good about details too, which is what you need to have when you work with patients. It’s serious work.

And you have those big old things you wheel out.

S: We have three carts. Med/Surg, CCU, and OB. We also do trays for ER, S.O.P, and we do late trays. The other day I had 11 extra trays between 8 a.m. and Noon in addition to the patients I had to feed. So it’s a lot. I think Jim said we put out about 900 trays a month.

D: And it doesn’t end. We have other things to do for the next day.

S: We make the side salads and green salads. Plus cleaning and dishes – lots of dishes.

D: So when you say, “What do you mean it’s only 1:31?” (lunch ends at 1:30), we have to get done and get out and do other things. People are pretty understanding about that.

But it does help for them to have perspective that ‘it’s not just you.’

S: It’s not just you or your department, but we have all these departments calling down for service, crackers, juice, whatever. We also supply Cle Elum and the clinics.

Serving patients and café customers, each day brings with it three meals that require planning, shopping, prepping, cooking, serving, and cleaning up after. Every FNS team member is necessary, and has an impact on the end result: tasty food, ready to eat.”

Does anything come to mind when I ask what misconceptions people might have about Food Services that you’d like to clear up?

S: Some people think we sit in the back and eat cookies all day long, which we would like to do, but, no, it’s very detail oriented and can be hectic and stressful.

D: Everybody has to do dishes. No one’s exempt. There’s no designated dishwasher.

Wow.

S: In a way, we’re the backbone of the hospital. Everybody wants to eat. When you get a good meal, then you feel like being productive.

There’ve been a lot of changes and things introduced since Jim Gallagher became the director. What kind of are you getting feedback from folks?

S: I’m getting good feedback about new menu items that we’ve had out here. He tends to go in a little healthier direction. We’ve got fish tacos now, carnitas tacos, and some other different items.

D: He’s willing to try new things.

S: And the grab-and-goes (refrigerated meal items) are his idea.

What kind of input does staff have into what kind of dishes get made or recipes get tried? Are you encouraged to get creative?

S: Oh, yes. We’re very involved. You might come up with an idea for a menu item, but it then you pass it around, you know, “What you think about this?” We bounce ideas off each other until we get to a good place – not only what the ingredients are, but how to prepare it, what to serve it in.

D: Like Vikki and her breakfast creations. “What if you put shredded hash browns in the potato bake?” Or our margarita pizza (mozzarella, basil, tomato). Vikki says to me, “Why can’t we make like a sandwich out of it?” “Well, what kind of bread?” “Let’s use the crusty bread.” “How are we going to put these together?” And Dwayne chimes in from back in the kitchen, “What if we do it like this? And should we put them on the grill or should we do it this way?”

S: It’s total collaboration. Jim encourages us to be creative. He and I make menus together, but then we bounce it off the people on the front line, because they’re the ones that it impacts.

The rest of us just see the end, where it’s put nicely on a plate.

What’s something that might surprise people about the work that you do?

S: We’re very adaptable. When we’re out of something or something isn’t exactly as we planned, we can change directions and still have a quality product.

You are food ninjas.

D: I really enjoy doing patient meals.

S: We always love the cafeteria but patients have to come first. They are our priority.

What are the challenges of working in your area?

D: There’s so much going on and so many people in the kitchen, it’s finding a space to work, to get your job done.

S: We’re doing patient meals, cafeteria, catering – they’re all intertwined, and we’re all working on our own project.

What are the rewards of working in food services?

S: Doing a good job. Making somebody happy. Having that feedback of, “Hey, you did a good job.”

The cafe has a good reputation in the community, too.

S: Especially the salad bar.

What do you need in order to have a great day at work?

S: I have to have one pun every day that makes everybody laugh. We just get along really well. It’s like a super-dysfunctional, happy family.

D: Being able to joke and laugh makes the day better. Just being with people you enjoy working with.

S: Everybody brings their own unique skills, their own personality and we all make it work.

The mission of KVH is to provide quality patient care. How does your work support that mission?

D: We make our patients happy with a good meal. It’s really cool when you get the little notes back, saying something about what a great meal it was.

Think of all the patient care staff, on a 30-minute break – being able to eat a meal on campus, that’s huge for them.

S: Bottom line, food makes people happy, and that sets the tone for the rest of the day.

Materials Management

Behind the Scenes: Materials Management

HealthNews · Sep 17, 2019 ·

Materials Management

We sat down with some of the Materials crew for insights on how they make sure we have what we need, when and where we need it. (Photo: Materials poses at the hospital’s back loading dock.)

“A par level is an inventory management method through which you determine the minimum amount of stock you always need to have on hand.” – dashboardstream.com

Morgan (M)
Bonnie (B)
Michael (MB)

Materials is a generic term. What does it represent?

M: It’s basically all the supplies needed to run the organization and to support patient care.
Are there various roles on the team, or does everybody cover the same areas?

B: No, we have various roles. The techs do all the inventory control, making sure all departments are filled to the par, and also they do all the shipping and receiving.

M: There’s also the buyer role, which is Bonnie and Rhonda. Bonnie is the OR-specific buyer. And Rhonda does all the rest, and Med/Surg. And there’s my role as director. The whole team is great at supporting one another with their workload whenever possible.

The technicians go out and inventory?

M: They make sure that the departments are stocked to their par level. Each item that is stocked in their department is set at a level. So it could be that they have five of something or they have a hundred of another. Our Cerner system tells us how many of each item each department should have at the beginning of the day.

But you’re going, they’re going out to the departments?

M: Every single morning. That’s why they start so early. They do the clinics and all the departments in the morning. They go out and scan first thing, come back and pull all the product that’s needed, and then go back and stock it. Then again later if they need to delivery additional orders that have come in. The team puts on a lot of miles each day.

Does materials stock the entire organization or just the hospital? I’m assuming there’s nothing to stock up at Radio Hill.

M: Home Health sends bins and totes down every day for us to stock and send back up with the courier. We support all KVH clinics. We also provide supplies to external entities as well, so if KVFR is out of a supply and they need something, we will issue it to them. 

Are there any misconceptions about Materials people might have that we could clear up?

B: Maybe that our jobs got easier when the departments began scanning their items?

M: That would be a major misconception.

B: We still reset all the pars, when the levels get off from them not scanning, and we still have the same amount of work, filling blue bins, yellow bins, ordering product.

What would surprise somebody about the work you do here?

MB: I know when I started working here, I was surprised that this small department covers orders and supplies for all the clinics, and the hospital.

What are some of the challenges of working in materials?

B: Not getting enough information to place orders. The amount of back and forth we have to do from not getting all of the information…

MB: It’s a lot more complex than most people probably think.

M: And I think people get frustrated, too, when you ask them for more information. I’ve always told the team we’re not going to play “Bring Me a Rock,” because I don’t know if you want a big rock, a little rock a flat rock, a jagged rock. You’ve got to give us a little bit more information, because we have hundreds of people every day asking for things, and if you don’t give us a little bit more information we cannot guarantee you will get what you need.

They’re going to get the wrong thing –

M: They are, and they’re going to be upset about it or they’re going to be upset that we have to email them multiple times with questions.

Do you have particular vendors or people you’re interacting with regularly as you place orders?

B: The main distributor is Medline. We try to get all of our supplies through them, except for things that they don’t carry or various times where it’s cheaper to buy direct. Then we do have multiple vendors. We probably have 20 to 30 different vendors that we place orders with daily. We have a buying group called Intalere. We make sure that we’re getting the best value and the best rebate back from purchasing.

And then random stuff happens. Like, we need carpet for five buildings, and that lands in your world.

M: Anything that comes through the door comes through our area. We do pretty much all of it except for Pharmacy, Food & Nutrition Services, and some of IT. I chair the capital committee, so all capital requests come through us. We get quotes with buyers and have to run it through analysis, through MD Buyline, to make sure it’s cost competitive, that they’re giving us the best price, that they’re referencing our contracts, then we present it to capital. We get all of the supply requests for remodels and builds. MAC (Medical Arts Center) is huge on my plate right now.

B: Everything funnels through here first, which kind of makes it so everybody thinks everything comes back here.

M: Office Depot is the only group that actually will deliver to ancillary locations. Other than that, every single purchase order and every single purchase has to come through these doors, which is frustrating for clinics up in Cle Elum because there’s a delay while it gets here, gets checked in, and then sent up.
But if we weren’t checking things in, there’s a downstream effect for Accounting where it doesn’t show it was received in the system. We don’t have an accurate way of tracking it if it just starts going out to other locations before we have a chance to check it in, to check the quality, to make sure it’s the correct item. That’s why this has to be the central hub for all incoming products.

What are the rewards of working in Materials?

MB: Definitely the people

M: I think our team is amazing.

MB: We all get along really well, and that can make or break the job.

B: The team dynamic that we have right now makes it nice to be here, even when it is stressful. Everybody pitches in and helps one another. We look out for each other and care about each other.

M: We have a good time when we’re here. We laugh, we joke, you know, it feels like you’re spending time with your friends and your family. And you don’t always get that at work.

MB: This position goes to every department. You get to see, a little glimpse of the goings-on and to meet people from almost every department, too.

Are you expert packers? (“No!!”) Do you get cardboard cuts? (“YES!”) You ought to get hazard pay for that. So what does it take to have a great day at work?

M: No backorders.

B: That’s another thing I think people don’t realize, is how much time we spend navigating backorders, substitutions, and trying to make good decisions cost wise; that it’s going to work for the facility, just how much time we really have to spend on each order, and making sure it comes in correctly.
How does this team’s work support the patient care mission of KVH?

B: Getting supplies in a timely manner at the best cost possible, making sure that everybody has what they need to provide patient care, and that we’re also providing a service that is cost effective.

Imagine if we took Materials out of the equation and clinic staff had to run over here and try and find something or place an order when a provider runs out of supplies. I guess, in a good way, you’re taken for granted because everything is where we need it when we need it for the most part.

B: I think the surgeons would realize pretty quickly if they were short on supplies.

M: Bonnie’s great about looking at the OR schedule ahead of time. Two weeks out, she’ll look to make sure what’s on there. She’ll know what supplies are needed based on their preference cards. She’ll make sure that they have enough on the shelf.

That’s amazing. That’s a direct impact on patient care. Thanks for the work you do to keep us equipped and ready to provide quality care. Clearly, we couldn’t do it without you.

Environmental Services

Behind the Scenes: Environmental Services

HealthNews · Sep 10, 2019 ·

Environmental Services

We sat down with some of the team that keeps our facilities clean. 
McKenna – 2 years
Patty – 12 years
Paula (PC) – 31 years
Sara – 10 years

What does environmental services look like? Is it different in patient care areas?

PC: I do the Critical Care Unit, Imaging, Surgical Outpatient, three rooms on Med/Surg, the Doctor’s Room and Social Services.

M: Some deal directly with patients and some don’t. Some of us do offices.

S: I do both. I deal with offices, the cool crew up here, you know, and I deal with patient areas too, so I have both sides.

Who works in the clinics in this group?

S: Me.

P: I used to work in the clinics, and now I’m in the Emergency Department. I really enjoy the faster pace there.

Does environmental services handle the OR? That’s like a whole other level is it not? I mean, I know you have to have things clean, but, like, there’s *stuff* going on in there.

M: It’s pretty detailed. After a surgery, I go in, take up the trash, then move everything to the middle of the room and mop the ceiling, mop the walls –

Why do you move everything to the middle of the room? I’m picking up housekeeping tips.

M: So I make sure I get everything and don’t miss anything.

So you move everything to the middle of the room and then you sweep, you mop –

M: No, we can’t sweep. No dust is allowed back there. I can’t use a duster. You just don’t want a lot of dust in the air. So I mop the ceiling and I mop the walls.

You mop the ceiling? That’s something I didn’t know.

M: Yeah, it’s basically like a microfiber flat mop. So I can throw it away. It’s a one-time use. And I have a pole extension so I can get the ceiling.

That is crazy. But you know there’s a concern that everything be clean, so, okay. Wow. Okay. That’s just the tip of the iceberg, I’m sure.

S: It’s the same as what you do if you have a contact room, like if you have MRSA, you basically have to do the room the same way. With surgeries, you do the ceiling and the whole thing once a day at the end of the day, unless we have totals, which happens on Tuesdays.

(For the more sensitive souls out there, I’ll just summarize what they shared next, and say that total hip replacement surgeries need to be cleaned up after, every time. Now, back to the interview.)

So when you’re doing a room in Med/Surg or CCU, there are different signs on the doors, right? They’re clues that something’s different about this room. Tell me about those.

PC: We have a sign that is brown and that’s enteric. So you clean that with bleach water, 1:10 (ratio) bleach water solution. Droplet is the green sign. We use Virex disinfectant cleaner for that. We have the orange signs for contact. You have to go in there and use your Virex, change curtains, wash walls…

Do you guys mask up for any of this?

S: Yes, and you have to gown up.

PC: With droplet, you have to wear a mask. With contact and enteric, you have to wear a gown.

Is there always somebody here on duty? 24/7/365/Christmas day?

S: Every day, yes. And pretty much all day. From 1:30-3:30 there’s a night janitor available to help with anything that comes up.

PC: I’m here at 4 a.m.

How are the clinics and outbuildings handled? Are there dedicated staff for clinics?

S: There’s someone that does Family Medicine – Ellensburg, Orthopedics, and Pediatrics, so they just clean those. And then there’s someone that just does Radio Hill, Physical Therapy, and Occupational Therapy & Speech Therapy. Then there’s Laura, she does Internal Medicine and Workplace Health. I do Women’s Health, General Surgery, and here (upstairs at the hospital).

So in the hospital, this is the place where cleaning could happen at any time, but with the clinics and the external buildings, it’s pretty much before or after hours.

S: Right. When the clinic staff leaves, then the housekeeper comes and cleans.

Environmental Services is an 18-person crew, plus 3 in Laundry, responsible for keeping clean 135,000 sf of KVH facilities.

Are there any ideas people have about the work that you do that you want to correct?

PC: Well, some people think that literally all we do is mop the floor and collect garbage. It’s more detailed than that. I’ve actually had patients say to me, “Oh, you got the fun job cleaning up after us,”  and I go, “Well, you know, it pays the bills.” (Laughter) And I’ve done it for a very long time. So then they ask me how long, then they say, “Wow, you’re a lifer!”

One of the things I forget is that your jobs are 100% on your feet, all the time.

Is there anything that might surprise us, like mopping the ceilings, about the work you do?

M: You’re tested on how well you clean the room. There are invisible dots everywhere.

Oh, what? Tell me about this!

M: It’s from the company Ecolab. Before surgeries, someone will go in and dot the room with these little invisible dots that I can’t see. After I clean, they go in with a black light and see if the dots are still there.

Is it some kind of substance that would come off if the surface was cleaned, is that the point?

M: And you can’t just wipe it, you have to really rub hard on it to make sure it’s actually gone.

How often does that happen?

M: Several times a month.

S: They do it in Med/Surg and CCU, too. And OB, when you clean the C-section room, there’s a checklist, so someone has to check everything in that room to make sure that it’s clean. So it’s not just your eyes that have been on that, it’s other people, too. So that’s kind of cool.

Well if you think about it, like the number one piece of health advice that people give is wash your hands. And I don’t know if you realize or if people think about how important the work is that you do, because if we didn’t have a clean environment here, can you imagine how sick everyone would be? So, bless you for all you do.

What are the challenges of working in environmental services?

M: When someone calls out sick, because then you’re covering multiple areas.

S: Being in more than one place at a time. It’s like, be here, do this, do that. And the hours, you know, the hours aren’t always super ideal. It’s common for people at KVH to have an 8-4:30 job, but most people in our department don’t.

What are the rewards of working in your department?

S: I would have to say, the people. Speaking for myself, General Surgery, Women’s Health, the people here. At first, I never wanted to work upstairs ‘cause it’s all administrative staff. And now that I’ve been up here, I really like these people. I can get used to working up here, you know?

Let’s put it this way. If you’re that special person who loves cleaning, then maybe that’s what you like. But otherwise I would think it would be about the patients, and the people.

M/S (unison): I like to clean!

PC: I really like interacting with patients.

It must be tough, ’cause you guys have physically demanding jobs, but you have the opportunity to be a bright spot for somebody that’s probably not having a good day. I’m sure you are very much appreciated by patients and families.

What does it take to have a good day at work?

Everyone: Sense of humor!

PC: Also have a positive attitude and respect each other.

How does environmental services support the KVH mission of providing quality patient care?

PC: A clean environment, I would think.

M: We help not to spread infection.

S: Yes, infection control. Make sure everything’s clean.

You’re protecting patients, right? And staff. You should have police badges. I’m seriously in awe of the work you do. Everyone else will be, too.

Engineering

Behind the Scenes: Engineering

HealthNews · Aug 30, 2019 ·

Engineering

INTERVIEW #1
We sat down with the Engineering team to learn more about the ways they take care of KVH facilities. Mitch (team lead, with 12 years at KVH); Terra (department secretary, 11); engineering techs Robert (.5), Tim (8), Jody (26), and Ben (2).

Who’s the go to person for what, on your team? Jody’s the painter.

M: So is Terra. We go to Tim for locks and doors. Robert’s our HVAC guy.

J: Ben’s master plumber.

(To Mitch) And you’re the enforcer.

Tim: He’s the phone guy.

What’s the best thing about working in engineering?

J: We’re never doing the same thing, day after day after day.

What’s the most challenging thing?

M: The frustration sometimes of not being able to fix things as fast as they need to be fixed. It’s challenging. When heating goes down when it’s cold out, or the cooling goes down when it’s hot out, how fast can you get it going?

‘Cause you’re only going to hear from several hundred people.

M: Another challenge is the 13 houses that we own; they need constant care. And then we have all the outer facilities, too.

Including Cle Elum?

M: That’s where Ben is now. Ben’s our Cle Elum guy. We spend a minimum of one day up there every week. We have preventative maintenance that needs to be done. It comes in huge sheets. Hundreds and hundreds of things that we have to do besides emergent things.

There’s a checklist about a mile long is what you’re saying.

Your work covers such a wide range. Can you give me a simple definition for engineering?

M: General maintenance. And sometimes we have to actually engineer something to keep it working.

Any engineering misconceptions you would like to clear up?

Tim: We’re not security.

M: We’re part time security when needed. And we have these little vests we can throw on. Other than that. Yeah. I think they look at us like we are, it’s not what we do.

Any other misconceptions or surprises?

M: I’ll take people on a tour, and they get to talking about the heating and cooling, and to actually see how that works is kind of fascinating if you’ve never seen the large scale of it, with the giant chiller and boilers making hot water and cold water, sent throughout the whole building.

With surgery, there’s things that have to be a particular temperature…

J: And humidity. We have to control humidity. We fought it all last week with the rains.

You can’t change the weather. So how do you control the humidity?

J: By computer. There are units installed that can add humidity or dehumidify the surgery suites.

R: With room temperatures, people have different preferences, but we have to find happy mediums.

M: Our goal is to be 71 degrees. That’s, that’s the happy place, really.

I love that. That should be your motto.

So why do you guys come around to offices with a stick and a piece of ribbon attached to it?

Checking air flow. To see if air is blowing. If not, then that is probably part of your problem.

Now is that one of those checklist things that you do periodically or is that when you’ve got a complaint or both?

M: That’s if there were complaints.

You have supply and you have return. We want to make sure the air that’s being blown in is being taken out. If you go up on the heliport, you open the door to that fan and it’s a hurricane. That’s the kind of pressure it takes to fill the building. And if you’re going to pressurize it, you have to remove it, too. So we’re dealing with huge fans to make this work.

We think of “call” as a patient care thing, but you have 24/7/365 coverage. How does that work?

M: We rotate. We each get one week, through the weekend.

J: From Monday to Monday.

Have you ever been called in in the middle of the night?

J: On a weekly basis, yeah.

“It’s 65 degrees. Get down here!”

R: Sometimes people think we’re not getting to their problems, but it takes time to fix things. And with outside vendors, we’ve got to wait even longer. “I put that two weeks ago.” “Yeah. I haven’t gotten the part yet.” And then there’s money concerns. I mean, if it’s a big item, we’ve got to wait for approval. People can get frustrated waiting.

I think a lot of us are used to instant fixes. Right? Need to get that fixed in 30 minutes or less.

M: You may have a light out right here for you in your office. We go through the work orders and make sure that the patient care items are handled first.

I’ve heard you say that before, that you prioritize patient care. It’s why I’m always shocked when somebody shows up for my thing. I’m like, don’t you have a list a mile long of really important stuff?

R: We might be waiting on a part! (Laughter)

You all work so hard. How do you survive a day in engineering?

J: What keeps me coming back every day is the crew that I work with. The people on this team.

You’re in it together, right? That makes all the difference.

Baseline responsibilities: 2,000 pieces of equipment, 3,597 PMs, and 33 systems

INTERVIEW #2
Director Ron Urlacher currently spends about half of his time focused on facility renovations. He’s grateful for a capable team that expertly handles the department’s ongoing work. Ron shared some additional insights with us about the work of KVH Engineering.

One of the difficult things to wrap my brain around is defining what Engineering does. It seems like a pretty broad spectrum.

Ron: And it is. Maintenance calls – plugged toilets, changing lights, hanging up whiteboards, all those little things – and lots of square footage to take care of, including the district houses, with lawns to be watered daily, garbage to be set out for weekly pick-up, and general maintenance.

When one of those systems goes down you have to put on your problem solving hat. It’s a whole different skill set. Even if you can’t fix the problem, you need to understand the problem so you can call the right contractor and relay the right information so they can come prepared.

For example, let’s say an air handler goes down. You need to determine if it’s a mechanical problem, electrical problem, control problem, or other system feeding it such as boiler or chiller and everything associated with that. With each of these problems come different contractors. It could even be IT infrastructure as our controls are computerized. Anyhow, that’s when the fun starts.

We also handle office moves, interjected into the normal workflow. And there’s all the preventative maintenance that we do. I wish I had a count of the pieces of equipment.

I’m sure it’s hundreds or thousands or…

Ron: Literally. And each piece has to be maintained. Which gets into the world of compliance. A lot of things have to be documented on a regular basis, things that inspectors look for.

How is engineering different in a healthcare environment?

Ron: There’s so much variety. The hospital has 33 distinct systems we manage and maintain. There are some commonalities, but each system is unique. Trying to keep up on the science of all those is a challenge.

How does Engineering support the mission of KVH?

Ron: Through safety, really. Some of these systems are high risk. Like when a patient is on oxygen, the expectation is that oxygen will flow and that’ll flow at the right rate and it won’t be liquid, you know? It’s about creating a safe environment. We work behind the scenes so that you can take it for granted.

Patients won’t even realize that you’re there, because everything is working as it should be.

Ron: Exactly. I always say if they don’t see you, that’s a good thing.

Central Billing Office

Behind the Scenes: Central Billing Office

HealthNews · Aug 5, 2019 ·

Located in two separate facilities, the KVH Central Billing Office covers a range of services and responsibilities. We sat down with three long-time CBO employees for a glimpse at the work they do to serve our patients, the community, and the organization itself.

Photo (L-R): Tara, Kelly, Leah

Leah, you and Jill and Yvette are the faces of KVH Hospital. What’s a typical day for you?

L: As a Registration Clerk, I register hospital patients for all the different areas, like lab, imaging and emergency. I also train our staff on the patient registration process.

Does everybody in Registration work the main desk and ER?

L: Yes. We train everyone to work at both.

What was it like for you when you first started here?

L: Well, I’ve worked in healthcare since I was 18. Before I came here, I worked at Swedish and at Overlake Hospital. So I was able to draw on those experiences.

So, say somebody comes up to your window and they don’t feel well or they’re upset. How do you deal with that?

L: I’m very compassionate with patients. Some come regularly for care. One patient comes to mind who, when she checks in, she could be crying or happy, but I always reach out my hands for her to grab onto, and she feels better right there.

A lot of folks get comfortable with you and they don’t want to go to anyone else to get checked in. I try to do everything I can.

Tara, what is the billing office like?

T: No day is the same, with the constant changes in payers (entities paying claims, such as insurance) and healthcare.  We review claims for errors and fix them, submit claims to payers, do claim/denial follow up, post payments, send patient statements, and do self-pay follow-up and collections.

And as Billing Office Supervisor, what does your team look like?

T: We have three billers for primary (main) insurance, two billers for secondary insurance (which happens, for instance, when a patient has insurance through their work and also has coverage through a spouse’s insurance – one insurance is primary, the other is secondary), two self-pay financial counselors, a revenue cycle clerk who collects patient payments, and a cash poster who posts patient and insurance payments.

Kelly, what do you do?

K: I’m the Charge Master Coordinator. Tara and I’ve been here just about the same amount of time – 14 years, and some change.

I manage the charge master, which is a database. Anything that could possibly be charged, for clinic and hospital care, is housed either in our charge master or in the pharmacy’s charge master. I work closely with Coding and Billing to ensure every CPT (Current Procedural Terminology) code is attached to a charge, that the codes are correct, that they’re hitting the bill correctly, and that we’re not overcharging.

I audit a lot of accounts. The Quality team reaches out if they need a chart audit done. So by the time it hits my desk, there’s a problem or it’s one we didn’t look at. And then they’ll have denials or claims that won’t get pushed through because something’s wrong. So I look at those, as well.

When people ask, “What do you do?” I’m like, “It’s probably easier to say what I don’t do.”

How have you spent your 14 years at KVH?

K: I started actually in Revenue Cycle Management, which at the time also covered nighttime registration. I did a lot of the cash posting and chart auditing.

T: I started working as a Registration Clerk right out of high school, and also worked for a short time in Home Health before I came to Billing.

So, you all spend a good amount of time on the phone in your jobs. How do you feel about that?

L: It’s more about how the patients feel, right? Until recently, when folks called for Imaging, we’d answer the phone, then they’d be transferred to Imaging’s phone tree. It was backwards. Now, when you’re calling the hospital, a phone tree picks up with options for Billing, Imaging, Lab, HIM (medical records), and ‘Other’. Callers can select ‘Imaging’ and connect with a live person in Imaging. It’s so much better for patients.

Tara and Kelly work in traditional office settings, but your work environment is…

L: It’s like the mall. (Laughter)

With busy times and quiet times. What do you do when there’s no one to register?

L: We have other duties, and we try to do them when we can, but it’s tough to get things done between patients, so we do more on the weekends and early mornings and evenings.

So you didn’t mention the mail, you guys do mail?

L: We take mail out in the morning and then I take it in that afternoon to the post office. 

I’m sure it’s fun when somebody does a massive mailing.

L: Like Marketing. (Ouch!)

What are the challenges of your jobs?

T: One of the biggest challenges we have is keeping up with the changes in healthcare as everything effects our department.

K: People don’t think about us until the end. Absolutely everything that happens upstream stops with us. If it’s broken, if it’s not working right, if the charge didn’t drop, if the documentation isn’t there to support the charges, if there’s the wrong information on the claim because it was registered incorrectly – things that if looked at upstream would make our jobs a lot easier.

T: We have really been working to improve the communication between departments organization-wide. We have implemented weekly and bi-weekly meetings with other departments to discuss any current issues we may be having.

As billers, we are wired to correct issues regardless of where they originated, so we can quickly get the claim out the door. Because of this, we’re not always the best at communicating those issues. That’s why we’ve implemented Registration and Coding work queues, and are able to send any issues we come across back to the departments for corrections. Plus, when we implement changes like these, we see our AR decrease.

L: For registration, the challenge is making sure things are done accurately from the start, with the right insurance and demographics for the patient. Our CFO recently told us our self-pay list went from 4% to 2% after all the training we did at the clinics. That’s a good improvement to help with Billing’s challenges.

In your roles, you’ve got to be compassionate, but do you ever feel like you are absorbing people’s stress? Are you there for each other?

L: Definitely. We also have good bosses. In Registration, Yvette is there whenever we need to troubleshoot or be encouraged.

T: We’re a family. We really are. We’re pretty blessed with our departments.

So you kind of tiptoed into the next question: what are some of the rewards of working in your areas?

L: I love challenges in my job. If there is an issue, I usually can fix it. And when my shift’s over, it’s over. I can go home and be with family and leave work at work.

How do you see what you do as being part of the mission to provide patient care?

K: We talk the patients through complaints a lot of times before they even get to Quality. We’re able to work out billing issues, charge issues, things like that. If we keep the patients happy, we keep them coming back. You know, times are tough right now. Just having a conversation is helpful for many patients, who don’t necessarily understand their insurance, let alone charges from the hospital. Just giving them that additional information, then they’re like, okay, I get it. Nobody wants to pay those bills, but they get it, you know?

T: Even though we’re not providing direct patient care, we are the last department that the patient encounters, so we have a huge responsibility to meet their needs – whether that’s explaining their charges or insurance benefits, or helping them set up payment arrangements. One of our biggest challenges is that most patients don’t understand their insurance benefits.

Anything else you’d like to share?

K: It’s always important to remember what it was like before we got involved in healthcare: how much did we really know? You know, you presented your insurance card and you didn’t worry about it. Remembering that, and having understanding and compassion for patients is so important.

We all feel that way, and it helps that we work with a really good team of people.

Finance

Behind the Scenes: Finance

HealthNews · Jun 19, 2019 ·

Finance

We sat down with KVH Senior Finance Analyst Jason Adler and Accounts Payable Specialist Deborah Connors, to try to get a handle on the mystery that is healthcare finance.

How is the work divided between the team in your department?

Jason: Accounting is a part of finance, and finance is also the whole revenue cycle. They all partner together.

Deborah: And you do a lot of budgeting.

Jason: I do the budget and it rolls into accounting to compare the budget or financial plan to the actual accountings.

Deborah: I have a very small part of the whole accounting department. Pretty much just paying the bills.

Jason: Well, I think she has a really big part. How much money did you spend last year?

Deborah: You know, I don’t remember, but I did hear Kelli [Goodian Delys, Finance Director] say that I wrote over 10,000 checks. One night I was here until 7:30 doing checks and someone’s like, wow, you’re here late. I’m like, I’m just trying to keep the lights on.

Jason: Literally.

If you were to give a really high level of what your teammates do, what are the different roles? Kelly Winters does payroll.

Deborah: Kelly does payroll. I pay the bills. Vicky Sterkel pays the bills. She enters employee deductions and things like that. She also sorts the mail that comes in and helps do a lot of data entry in Cerner for matching invoices to purchase orders.

And Sharoll Cummins?

Deborah: Sharoll does just about everything else.

Jason: She puts in journal entries to account for things like bills we haven’t paid yet, like when a company bills us about a month behind, but we need to expense it at the time of service to ensure we have the money for it.

Deborah: Sharoll also keeps track of all the fixed assets, whether it’s a new computer system or a building.

What program do you use for all of this work?

Jason: We probably use Excel the most. Multiview is our general ledger software. So that’s where everything comes together in our general ledger, which is like the book of truth, I guess you would say.

What’s different about working in finance in healthcare?

Deborah: I had to learn a lot of terminology. My first six months I googled a lot of things, many of which I wish I’d never looked up. But, accounting is accounting. The basic principles are the same. It’s just the terminology that is a little bit different.

I just know from my perspective in marketing, but marketing in a healthcare environment has that layer of ‘it’s for a greater good.’

Deborah: That is actually part of what drew me to wanting to come to work here. You know, being part of an organization that does good things for people.

Jason: I guess one of the biggest differences with healthcare is learning how we actually get paid, and what we can charge for. Every payer pays us differently.

Deborah: Incredibly complicated.

Jason: Yeah. And contracts with insurance companies will conflict. You might have a contract with one insurance company where a service is allowed and paid for and another company that is complete opposite.

Deborah: There are a lot of things that are very negotiable.

How do you keep all of it straight?

Jason: It takes the whole team. There’s little things like with Medicare and Medicaid where location is really important on how you get paid. We can do the exact same service in two different areas and what we get paid for the services can be significantly different.

Deborah: And even things like the utility bill. Engineering absorbs most of the utility bills into their department, but not all. The ones for the Rural Health Clinics get charged to the clinics, so they can be included on the Medicare Cost Report reimbursements.

I think that’s the single biggest thing that I learned since coming here, is how complex the entire finance system is.

Jason: We do the cost report, so we’re paid on cost from Medicare and Medicaid, which is about 60 percent of our business, but pays about 33% of our costs by the time we factor out all non-allowable expense. It’s just accuracy with the most basic things such as square footage of my office compared to a patient room. Just the square footage makes a huge difference on payment for services.

Speaking of having numbers right, how often do audits come into play?

Deborah: Two a year.

Jason: The state audit, and the independent audit.

Deborah: It’s my understanding that government agencies whose revenue exceeds a certain dollar amount are required by law to have independent audits done on an annual basis.

Jason: It’s required that the board choose a firm for the independent audit. Our firm is DZA and they just did the report out at the last board meeting. We have a state audit every fall.

Deborah: We don’t just go, “Hey, it’d be a great idea to get audited.” It’s required by law.

Jason: We’ll have payers do audits, too. We hire a third party audit to audit patient accounts. Just at random, to check that we’re doing a good job.

Deborah: And that’s a big part of the audits. It’s not just “What are you doing wrong?” It’s like, “This is the way we’ve been doing things. Can we do it better?”

What are the challenges of finance?

Deborah: I have a huge volume of work that comes through. It never stops.

Jason: Yeah, the volume’s a big one. I’ve just learned that even though I’ll have some periods with tighter deadlines, I do what I can, and at the end of the day I go home, because it’s never really done.

Rewards of working in finance?

Deborah: I like solving puzzles. Accounting’s a big puzzle. Sometimes you don’t know what it’s supposed to look like, and I like that part of it.

Jason: Being part of a community hospital and community health care. I know that I need health care, my family needs health care, and it’s great to be a big part of this and then know the numbers, the behind-the-scenes of why we do everything.

We try to keep it improving continuously for the small community. It feels like I’m actually helping friends and neighbors, unlike a big city where it’s thousand people I don’t know. I see patients I know every day. It’s really rewarding.

What would you tell a new teammate to bring with them for a successful day on the job?

Deborah: I’d say patience and a sense of humor.

Jason: Ditto. Especially patience.

For many of us, being in a hurry with our work can create more problems than we’re solving.

Deborah: Yeah, that’s true. I usually find when I’ve made mistakes, it’s because I’ve got rushed through something.

Jason: I like to try to have a second set of eyes on things.

Any misconceptions that folks tend to have about finance that you would like to dispel here or anything that people might find interesting about your work?

Deborah: Well, I don’t think accounting is boring, but a lot of people do.

Jason: Yeah, I don’t think a lot of people are going to find accounting interesting.

Well, but they’re seeing it from the outside, right? Getting directly involved in it might make it interesting.

Deborah: I think people might be surprised to learn that just because you work in accounting doesn’t mean you don’t have to be able to relate to people really well, because a lot of what we do is talking with people. Even if most of it’s in emails and spreadsheets, you still need to be able to communicate really well to do accounting.

How does your department’s work support the KVH mission of quality care?

Jason: Well, there’s access and financial sustainability too, right?

Oh yes. Our core values. If you couldn’t afford to have the doors open. You said something before about the lights being on.

Jason: Well, timely bills keep supplies coming in and the lights on.

Deborah: And monitoring those expenses in addition to the revenue, just to make sure that we’re not paying more than we need to, that we’re not getting taken advantage of.

You also are making it so that there’s a future here. We have, like, rainy day funds and we have operating costs and, I mean, all that stuff is all, you know.(Because clearly, I don’t know.)

Deborah: And in that way it’s not a lot different than your household budget. You always have to put a little money aside because you never know when that money coming in might slow down.

Just on a much larger scale here.

Jason: Exactly.

It’s pretty important work you all do. I still don’t understand a lot of it, but I’m really glad you’re here to take care of it all.

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