Gloria D. Brooks
President and CEO
Arbor Hospice Inc.
WHY SHE’S A CHAMPION OF THE NEW ECONOMY
When Gloria D. Brooks took over as president and CEO of Arbor Hospice Inc. in early 2007, she faced an operating deficit of $2 million and a looming net income loss of more than $750,000. Since then, she’s turned the company around by cutting costs, retraining staff, and selling off a line of business — all while enhancing patient care.
What was job one when you became president and CEO?
Right away, I did an analysis of all of our lines of business to see what was and wasn’t working. We had to stay focused on our core mission while figuring out how to streamline our back-end operations. We had a separate line of business for skilled home care, and at the time we were seeing 200 hospice patients and 20 skilled-care patients — which wasn’t the most efficient way to operate. We sold off the skilled home care business. We also took a look at our operations as it related to staffing needs, and developed a better way to balance our staff without impacting any critical resources. We had a reduction of 16 employees in 2008 and 2009. We also took a good, hard look at technology gains. The company had purchased an electronic medical records system, but the system hadn’t been implemented fully. It took almost two years to get it up and running, but it’s made us much more efficient. In addition, we have 220 employees now serving 235 patients a day, where before we had 200 employees serving 220 patients. We haven’t added any managers; [we’ve added] critical-care employees.
How did you account for national Medicare reductions in 2008?
The [cuts] continue to be rolled out. It really has been a challenge for all hospice providers. Reimbursements are being reduced but what we have to provide, in terms of meeting new regulations, is being increased. If a patient stays beyond six months, he or she needs to be recertified so that reimbursements will continue. We’ve added two nurses to keep up with that volume. Also, the overall Medicare margins will change from 2 percent in 2008 to a negative 14 percent by 2019, so we’re working on accounting for that while implementing additional quality and medical recording systems.
How did you keep the financial challenges in 2007 and 2008 from impacting quality of care?
With all the changes we were making, we never cut clinical services. We actually added more things. We invested in laptops for our clinicians, so they [can] enter and review data at bedside. It’s much more efficient, and it allows our staff to spend more time with patients instead of heading back to their workplace to enter the data. That’s a change in business that everyone benefits from.
Looking back, is there anything you would have done differently to speed up the turnaround?
If you ask my staff, we went too fast. This kind of major change is difficult. If we didn’t change, we weren’t going to be around for the long term. Our staff now comes up to me and says, ‘I see why you did the things you did.’ One of the things we undertook early on was to make sure management was visible and interacting with our staff. We now do e-mail updates, we have an e-newsletter, and we really stepped up our communication. We are very transparent. It took my staff a long time to understand what was happening, but once we showed them the financials, it helped everyone see that we needed to change. From a mission standpoint, if we can’t take care of patients, we’ve really failed. I can’t stress it enough — and sometimes you have to say it more than once — but you have to build close relationships with your staff, and keep them in the loop as much as possible. It goes a long way toward building a stronger organization. We also did a lot of work to fix our workplace culture.
What mechanisms have you put in place to better forecast potential revenue losses?
When I came into the organization, we didn’t have a budget forecast in place. There was no dashboard. So we’ve really improved our financial outlook. We have key indicators now that the board and all of management look at. It’s a balanced dashboard. We really get management more involved in the budget process, and we explain it to our staff. We’ve kept our clinician-to-patient ratio low, so that our standards are very high. We could have saved money if we had boosted that ratio, but we wouldn’t have been able to provide the best care possible. It all ties into the bottom line.
What is the financial outlook for the current fiscal year?
Our fiscal year starts on July 1. We had net income in 2009-2010 of $122,000, and our projected net income for the current fiscal year is $385,000. It looks like that will hold.
What advice can you provide to other businesses and organizations that are facing declining revenue, especially in the health care arena?
You have to go in and take a hard look at what’s working and what’s not working. From a CEO’s perspective, there are times that you need to make hard decisions to make sure the company survives. Look at what you’re best at. For us, it all pointed to hospice care. You need to share your vision for the company with everyone, so your employees know this is the game plan and this is where you’re going. That translates to any company. As a CEO, you are going to make decisions that will make people unhappy at times, but you must do them. I must say it’s great to be on this side, as we grow the business, rather than working our way out of the difficulties. It’s been a great journey. What surprises me is that only 40 percent of patients who are eligible for hospice care use it. Nationally, people don’t always know when is the right time to call a hospice. And that’s become more of an issue with the sandwich generation; many families are focused on raising their children while watching over their own parents. We’re planning to do more outreach to that population, to get the word out that hospice care is a six-month benefit. For us, the average length of stay for a patient is two months, and the median is two weeks. People aren’t getting the full benefit that is offered. It’s our job, as an industry, to highlight the positive impacts of hospice care for patients and their families.