The ROX Interview: Rona Curphy

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Rona Curphy:

CEO of Banner Casa Grande Medical Center

Interview by Bea Lueck – Summer 2015

GC LIVING: Rona, what is your official new position?

Rona Curphy: I am the CEO of Banner Casa Grande Medical Center.

GC LIVING: And you were the CEO of Casa Grande Regional Medical Center, correct?

Rona Curphy: Correct.

GC LIVING: Give me a bit of history about you. You’ve been in the medical field for a long, long time, but not always as an administrator.

Rona Curphy: Right. I’m a nurse and graduated from nursing school many years ago.

GC LIVING: way to leave that, many years ago.

Rona Curphy: I went directly into critical care, so I worked in cardiac ICU for a number of years. Also did some travel nursing, so I couldsee other places in United States, landed in Wyoming, and was one of 90% of traveling nurses in this hospital. They finally got a director of nursing, and called me and said, “Would you head up our ICU?”

I went back to Wyoming for about ten years heading up the ICU, then took on their education and discharge planning department, and had the opportunity to do lots of patient care which I loved. That was the start of my move into administration. I was head of that department, and worked closely with the director of nursing.Then I had an opportunity to spend five weeks consulting in Australia, dealing witha nurse consulting and computer business.

I took that opportunity, five weeks off my hospital job and went to Adelaide, South Australia and did some consulting. Six months later, I moved to Australia and decided to start my own business, along with a partner, a previous Nursing Director I had met to do consulting and nursing decision support. I was there a little over a year and half before my father got ill in Colorado.

I felt being in Australia was too far and decided to come back, got a job in Colorado Springs as a director of the ICU, and then took on functions of ER and the burn unit. Then I made the decision to move to Fort Smith Arkansas where I started as Assistant Director of Nursing and then became the Director of Nursing at St. Edward Mercy Medical Center. I have been in management and leadership most of my career.

GC LIVING: So you joined Casa Grande Regional Medical Center as the director of nursing about ten years or so ago.

Rona Curphy: January 2002, I came here as director of nursing, Chief Nursing Officer (CNO) and Vice-President of patient care service, and have been here ever since. Casa Grande is a wonderful community. I’ve watched it grow up in that 13 and-a-half years. It’s a good place to live, and a great place to do good patient care. When I came, we had six previous CNO’s in five years which means there was not a lot of consistency in patient care delivery.

That was my job- come in and evaluate with the staff what was being done, what should be being done and how we could implement change. We wanted to make sure everyone was delivering the same care. And we were able to achieve that over the time I was there. In 2009, Marty Denier, the CEO, left, and the board asked if I would be an interim, so I took on the interim CEO.

GC LIVING: And you’ve been stuck with us ever since. [Laughs]

Rona Curphy: And I’m still here, and happy to be here. It is a great community. It’s the people! I see them in the grocery store, I see them at Wal-Mart or at Target, and it’s nice because you know the people you’re actually serving.

GC LIVING: We’re about 52,000-ish in Casa Grande. Your coverage areas, counting the surrounding communities is about 80 to 90,000 people but as you said, we run into people we know everywhere.

Rona Curphy: Exactly.

GC LIVING: So it is still a small town even though we’re growing up.

Rona Curphy: Now, in 2014, we’re Banner Casa Grande Medical Center. I know the people. I’ve told business leaders and everyone, “If you’ve got somebody in the hospital, and you want me to go visit him, please call me and I will personally go and visit that person, and make sure that they’re getting the care they want and that they’re really doing well in our facility.” It’s just a great community from that perspective.

GC LIVING: The medical field has changed so much since you began years ago in Casa Grande.What are some of the changes you’ve seen?

Rona Curphy: When I started in nursing, we didn’t have all the innovation that has come across in the last 10, 20 years. We didn’t have computers to do documentation, everything was hand written. Try to read not only a doctor’s handwriting, but the nurses’ handwriting so you can make sure you understand person-to-person what medication to give. It was difficult. And we’ve, over the last ten years, moved into a computer era.

Very few offices don’t have a computer system today. It makes it so much easier to make sure we record information about patients so the staff can understand what’s going on for the patients. We have systems in Banner Casa Grande ICU, we have Banner Telehealth’s TeleICU in our Intensive Care Unit, as well as in four ER rooms where we can push a button, and a “Critical Care Intensivist Physician” in either Mesa, San Diego, Greely, or Tel Aviv can immediately talk to our nursing staff or physicians and have all the information about our patient right there.

They can turn the camera on, and they can look at our patient, and really assist the caregivers. If you’re in an ICU in any Banner facility that has this technology, we have a better outcome, lower mortality than any other ICU. They can see the electronic medical record. And, if they start to see a trend we haven’t seen, they pick up on it immediately and call that ICU. It’s a phenomenal service to be provided in Casa Grande Arizona.

GC LIVING: So those are, just a couple of new specialty fields for physicians over the last few years, an intensivist and hospitalist.

Rona Curphy: Exactly. So most people, when they go to their doctor, they expect to see he/she in the hospital, and yet very few doctors actually come and see patients because they feel they’re more efficient taking care of patients in their office and they can see more patients. Instead we have hospitalist’s who are Doctors that only practice in hospitals seeing patients in the hospital from admission through discharge.

GC LIVING: What are some of the challenges facing the healthcare industry over the last few years?

Rona Curphy: I think financial issues and the whole issue about Medicaid. We’re still there with this Arizona Medicaid expansion.The governor, the legislation, and now there is the potential law suit. Expansion is about making sure that low income single childless adults can get subsidized healthcare. We have to do it cost-effectively. That’s our responsibility as hospitals and physicians; making sure that we’re the most cost-effective possible. We want to make sure everybody has access to healthcare.

A couple years ago, we really struggled with the amount of un-insured patients that we were caring for but getting no reimbursement and it is one reason why we began the search for a partner. We were very heavily debt leveraged which made it difficult with the increasing level of uncompensated care. One of the things we know is that it’s important for people to be able to get healthcare. During that timeframe, when AHCCCS (Arizona Medicaid) dropped, we had many people in our community who actually used our emergency room as their only access to care- a high-cost care setting as their primary care, because they couldn’t get in to see other people, because they had no insurance.

So that whole issue about insurance, and how you pay for it, we really need to move toward doing more preventive care. You want people to see their doctor to prevent them needing care in hospitals. In one sense, you think, “Oh, you won’t have as many patients, and will be doing my care differently.”

At Banner we are asking about that post- hospital setting. Once people have been in our facilities, how are we taking care of them at home? Banner is doing telehealth also at home for those patients with chronic illnesses. It is called BanneriCARE® which is now expanded – it started as a pilot in SunCity and now moving into Central Phoenix for those patients in the Banner Health Network.

People with chronic illnesses can actually be set up with a tablet-like device, and a camera. Instead of making patients get into their cars and go to a doctor’s office, they have doctor visits in their home. Electronic equipment checks their blood pressure to keep them as healthy as possible, and keep them out of hospital. It has been working phenomenally. We can’t wait to get that for our members in our communities in the future. It makes a difference that people can take care of their health right in the comfort of their own home.

GC LIVING: So when Banner partnered with Casa Grande Medical Center it was $87 million in debt – give or take?

RONA CURPHY: Yes, they paid us about that and we had about $68 million in bond debt and other assets including equipment and facility. It was a phenomenal deal and a great partnership.

Now so we’re one of 28 acute care hospitals. We now have access to things we couldn’t have gotten. We couldn’t have afforded eICU where we had to pay for Critical Care Doctors to sit at home 24/7 watching patients. But now, this community has access to technology that makes it safer for us to take care of patients.

GC LIVING: So you’re able to expand services …

RONA CURPHY: Absolutely.

GC LIVING: Expand specialties …

RONA CURPHY: Yes.

GC LIVING: A number of fields are not available in Casa Grande. If you needed to see a specialist, you were going to Phoenix or Tucson.

RONA CURPHY: We recently hired a couple of obstetricians, so that’s started. Dr. Bronitsky started and he’s at Casa Grande OB-GYN where he joined Dr. Salisbury and Dr. Ivey. Dr. LaShonda Carlton, another OB/GYN starts in August. We also hired additional general surgeons. And Banner Medical Group will assess our area to look at other specialties we need to bring to the area. It’s a constant job! What’s nice is they want as much care to be delivered at Casa Grande as possible. We’re not doing open heart surgery and neuro-surgery and there may be other specialized things that make sense to do in big facilities, but everything else we will have the ability to do right here. They helped us expand our surgery services based on bringing surgeons on board.

We’re looking at a whole campus master plan. Over the next three to ten years, what will our campus need to look like?? Three areas have bubbled to the top. Our Women and Infant Service area, we know we need to have a level two nursery which will help us keep higher risk patients. We started nurse practitioners in our nursery 24/7 in April to help move to that level two nursery. We have needed to expand the emergency room for a number of years, and the third area is our perioperative services area -surgery,endoscopy,and recovery room.

We’re developing this master plan to determine how it looks then to figure costs. That works through all of Banner as we go for best use of dollars. I think you’ll be hearing more in the near future about plans and expansions.

GC LIVING: Now there are a couple of modalities at the house that might be a little unusual for a regional facility; the Central Arizona Breast Center for one.

RONA CURPHY: Correct. We have the Central Arizona Breast Center, Desert Reflections Imaging, our out-patient imaging center, accredited sleep lab and Hyperbaric Wound Center.

We have services not normally seen in a community hospital. But back to the Central Arizona Breast Center, which is something I did in 2010 because we really needed something better for women. Dr. Ramon Mourelo came to me and said, “It’s taking too long for a woman who has a mammogram with a positive finding to get a biopsy or something else. That’s not good for women.” We said, “You’re right. Let’s create something where they get results quickly and get them into the pipeline for great care.”

Now we have a facilitator, Rebecca Fleuret, Breast Center Coordinator, who, when any woman has a positive finding, she navigates their care as well as provides support by giving them her personal cell phone number. They can call her 24/7, 365 days out of the year! It’s a scary time for any woman who might potentially have breast cancer and she wants to make sure to provide the necessary support.

GC LIVING: I know the hospital has been a recipient of the Susan G. Komen grant for a number of years. The grant provides free mammograms for women who either have no insurance or high deductibles. How does that benefit the community?

RONA CURPHY: Oh, it’s huge for the community! We have been a recipient for several years in a row. Last year, they cut down from sixteen recipients to nine in Arizona and we are still one of those. I attribute that to the management of the grant by Karen Kerr-Osman, our foundation director, and Rebecca Fleuret, our facilitator in the Breast Center. It helps women who do not have insurance, are under-insured, or have high deductibles. We get them serviced immediately. Not only do we have mammogram money with screening money, we have diagnostic money, so if we find something, we can help to do further diagnosis, stereotactic biopsy, and more.

The Komen Foundation has been exceptionally helpful. They have seminars on grant writing and management. Kudos to Pinal County Well Woman Health Check, they also do criteria-based mammograms. We might need to send them to Pinal County Well Woman HealthCheck first and they might send us to do the actual testing. Rebecca Fleuret has been phenomenal in managing all the functions the way Komen wants. That’s why we continue to get money, because we follow their guidelines to the letter.

GC LIVING: And just to expand on that a bit, if a woman does not have a referring physician?

RONA CURPHY: We do. We have a process through Dr. Francis Salisbury where he will write the referral. We want to make it easy for women to get that simple test that makes all the difference if they’re one of those few who will never get it done otherwise.

GC LIVING: What do you attribute having some of these extras here in Pinal County? I’m leading back to someone who was instrumental in bringing Casa Grande Regional Medical Center to this community and is no longer with us – that’s John McEvoy.

RONA CURPHY: John McEvoy was a wonderful person with a lot of vision. He made a true statement when they decided to move Casa Grande Regional Medical Center from the Hoemako Hospital location. He brought that vision and I was lucky to sit in the board meetings with him from 2002 to 2008. He was focused on what we could do for people. He didn’t want people to have to travel and that’s why we have the depth and breadth of services. Why should somebody go out of town if we could provide it?

The out-patient imaging, before we built the Breast Center, is an example. That’s something that could be done right there. They built it to make it easy for people to get tests done quickly as they move forward. The Sleep Center, for a community hospital to have a sleep center accredited as we have done is really unusual. But, people like to do their healthcare as close to home as possible and that was John McEvoy’s vision to do, and then Cherie McGlynn and the rest of the Board of Trustees who have really carried that forward.

When Banner purchased the facility, we kept our board as an advisory board and they realized how important it was to have community members through the strategic plan who understood our community. All previous board members are still on the advisory board and that’s a true testament to this community. People who want to make a difference in healthcare.

GC LIVING: Do you think, in hindsight, adding that whole wing was a smart move at the time, probably not one of the best moves because the financial market crashed the day after it opened?

RONA CURPHY: With 20/20 vision now, it made sense at the time, but in hindsight, we had that tower of 56 beds, [28 beds on each wing] and we opened it in 2004. In 2006, I shut down 43 beds of our old surgical unit. I’m not sure we needed the additional beds at that time, and it did add a fair amount of debt. But we believed in continuing growth, but you’re right, the market crashed all of a sudden.

GC LIVING: We didn’t have the real estate boom anymore anticipating the population increase. It was supposed to happen but didn’t.

RONA CURPHY: Exactly. But now it’s there and gives us the opportunity to do some of the expansions we think possible.

GC LIVING: OK. What are some of the nuances in medicine…the challenges. Obviously, the economic impacts healthcare providers everywhere from a single practitioner to a mega-hospital face. How is this effecting patient care?

RONA CURPHY: Peter S. Fine, president and CEO of Banner Health, talks about disruption. We are in a disruptive time now and it’s how we proactively address the issues that will improve our health system; this whole issue about insurance and access to care. Had we not moved into the Affordable Care Act, we wouldn’t have been in this disruptive state where hospitals and health systems are now taking e control saying, “What can we do? What makes best sense to take care of patients at a lower cost with high quality, the triple aim of healthcare?”

What is happening is how can we take control of health? How can we move into preventative care? We have responsibilities for what we call population health, the health of the population from the time you’re born to the time you die. Where can we impact that most? What is the best for our position? Where is it best to use different modalities such as telehealth so we can make sure we reduce healthcare costs? That’s critical. The United States has one of the highest costs for healthcare and we’ve got to figure that out. We’re positioned, in Casa Grande,as part of a large health system to be part of that change and really be forward thinking, putting our patients at the forefront of great care.

GC LIVING: I’m going to put you on the spot here.

Rona Curphy: Okay.

GC LIVING: Do you think insurance costs sometimes get between a physician and the patient?

Rona Curphy: Absolutely! You said you would put me on the spot, but I think we have to look at the whole issue of health care and insurance reform as well. It puts a piece in the middle that says, who is really directing patient care? Is it the physician, or the insurance company, when you have to get authorizations and referrals, when you get denials for necessary testing? Do I think we, as the providers, always do it right? No. But there’s got to be a better way to do it.

Banner is a pioneer accountable care organization – ACO. Some pioneer ACOs are starting to understand that risk from a very different perspective. It gives us the opportunity to look at that kind of reform we know needs to happen. It makes us look at issues in regards to costs as well. Banner has done very well as a pioneer ACO, but a lot of work remains.

GC LIVING: Do you think society as a whole has taken to running to the doctor’s office for every little sniffle or splinter, and there’s a level of abuse of the system?

Rona Curphy: I wouldn’t say society as a whole. I don’t think there is a general understanding of how those costs work, because they’re complex. Its complex how insurance companies pay individuals, pay health care, pay providers. Because that’s not well understood, people who go into doctors’ offices for every sniffle see only a small piece that is paid. They don’t understand the processes. We have responsibility to help educate the public. I truly believe there are abuses on both sides of the system.

GC LIVING: You talked about the emergency room. That’s one of the key elements of any hospital. It’s also one of the areas you probably receive the most number of complaints. “I had to wait.” But, sometimes, yes, you have a bad cold, but the guy who got run over probably needs to be seen first.

Rona Curphy: Right.

GC LIVING: Explain the triaging process to get the most critical in first, the rest later.

Rona Curphy: We have a nurse who triages patients, to determine the complaint and criticality. National guidelines help us know if they’re level 1, 2, 3, 4, or 5. It does help us make sure we serve the most critical first, to make sure we don’t let them get sicker than they are. But, every person thinks they’re pretty ill. It’s difficult when you have to wait and see somebody go in front of you.

One thing we’ve done is our emergency room physicians are in the triage with the nurses at least 12 hours of the day. For many, they treat them quickly, get prescriptions, and get them moving out. Others, at least, are started on treatment. We may put them in the waiting room while waiting for an x-ray or lab to be drawn, but we’re trying to come up with better flows, to help people understand that. Because it is also about communication.

Sometimes we don’t communicate what that wait is about. So, it’s hard for everybody. When you don’t feel good, you just want to feel better. If we do a better job communicating what’s happening,we’re going to do this for you now; it makes it easier for people to wait.

The other thing we need to do is help people understand the right place for care. The ER is easy to understand, because it’s open 24/7. And no matter what time of the day you know you can get immediate care. We also have an urgent care. It’s open from 9 a.m. to 9 p.m. It’s a little bit lower than emergent care, but for many things, we can treat very well in the urgent cares. The other piece is doctors’ offices. You can get in most doctors’ offices with a same day appointment. Not all, I’m sure. And how do we structure people to the right level of care, as well.

GC LIVING: Do you see more critical patients coming in from accidents on the freeway than in years past, or are they mainly transported by air into the Valley?

Rona Curphy: No, we still see a lot of patients coming in, transported. Some, depending, we do additional assessment from accidents. Many we can handle, but if it’s critical, we transport by air or by Southwest Ambulance to the Valley. One of the good things is that over the next, say 18 months, we hope to become a trauma level hospital. We’ll probably go with the lowest level first – a level 4 – because we really want to make sure we have everything in place for those patients. We see a lot off the interstate, and we want to make sure we’re doing the best. I think we’ve done it well, but we’ll have standards in place to continue to do it better. Over time, we might move up to a level 3 trauma facility. That’s really about doctor availability and we can do that.

GC LIVING: The higher level trauma doesn’t that require a neurosurgeon?

Rona Curphy: That’s level 1.

GC LIVING: Okay.

Rona Curphy: I don’t think we would ever be at a level 1, or a level 2, even. Level 3 and 4, we could handle those pieces.

GC LIVING: What are some new things on the horizon? You touched on the computer system, when you got the Cerner system. And then, the availability of the x-rays.

Rona Curphy: The PAC’s system.

GC LIVING: Yes, thank you. What are some of the other innovations on the horizon?

Rona Curphy: The biggest is telehealth. We currently have a telestroke program with Mayo in our ER and throughout our facility. At some point, we’ll transition to Banner. Mayo’s done a great job for us. We have been able to keep, probably 95% of our patients with stroke type symptoms in Casa Grande. And we’ve been able to treat them with the knowledgeable physicians helping us. We’ve had to transport fewer patients, and that’s good for patients.

The reason is, we had complaints that people were coming to our emergency rooms with stroke-like symptoms. They would go to the Valley, and be released later that day or the next. Why did they have to pay an ambulance bill? Couldn’t they have been seen in our facility? So we’re looking at other things with telehealth. We’re looking at telepsychiatry. When we had to close our behavioral health unit, we faced a problem in our emergency room with numbers of behavioral health patients we don’t have a place to send to. We have to leave them in emergency much longer than we should.

Being part of a system helps, because there’s Banner Behavioral Health in Scottsdale and Banner Thunderbird Behavioral Health Center in Glendale. Banner Health, has approved additional beds at both facilities next year. That helps Casa Grande, because it gives us a place to send patients.

GC LIVING: Some of the challenges that face our community are lifestyle related. Diabetes is prevalent in the community. What does the hospital do to help educate people about disease management?

Rona Curphy: We do a little of that now. I think we will do more as we move into this preventative care. Jackie Houston is our dietitian in our culinary services. She and her fellow dietitians do monthly group classes for diabetes because we didn’t have enough people to do one-on-one sessions. Casa Grande has a wonderful diabetic clinic that is run by Nilda Fimbres at Sun Life Family Health Center who does a phenomenal job.

But you’re right. We have a lot of patients with chronic conditions we can help educate to manage better so they don’t have to come to the facility. I do think we will start to see more clinics of some type and be able to handle that. I can’t tell you exactly what that will look like, but in this whole time where population health is becoming a reality we’ve got to do things in a very different fashion than we do today.

GC LIVING: How has nursing changed from when you began? Are nurses now more independent? Do they have more roles, more authority, more tasks?

Rona Curphy: There are lots of roles for nursing today where there weren’t in the past. They can work in home health, in hospice, etc. But the actual care delivery model with the exception of the fact they have computers now to do their documentation general care is similar to when I graduated years ago. What’s nice is, with the advent of having hospitalists there are people to communicate with more frequently, to help that autonomy, to help them do the needed care if they have questions as they move forward.

Nursing still has lots of tasks, but they are independent practitioners, and have a full scope of practice. When you recognize that, how do we make sure those new people coming out have the best opportunity at orientation to refine those skills? When you’re in school, you don’t see everything. At Casa Grande Regional, we had a twelve-week new grad program, to make sure they were out of the count, that they were really mentored tightly in those twelve weeks. I’m pleased Banner has the same type of program, maybe even a little bit more robust, and they can take more new grads in Banner facilities than we were able to. It was critical for me to make sure that our new practitioners felt safe, and practiced safe care.

GC LIVING: Now, from when you began, some of the fields that nurses can go into, like nurse anesthesiologist, nurse practitioners…

Rona Curphy: Wound nurses have a whole certification in our wound-care center. Our manager in that area is a nurse practitioner, and she will soon be able to, under supervision, be able to run that clinic from a provider perspective. Lots of nurse practitioners run clinics. We’re looking, Banner wide, at how to use nurse practitioners more, to really extend what physicians do across the board, because there is a physician shortage. Like in our nursery. We will have a nurse practitioner 24/7 who is a neonatal nurse practitioner who has responsibility to visit the neonatal associate physician, but they will be able to manage high level care.

GC LIVING: What else haven’t we covered that you would like to discuss?

Rona Curphy: Two things. I would like to tell you a really special, “Thank you.” You brought up John McEvoy, but I also want a special thank you to the board of directors of Casa Grande Regional Medical Center. It’s a tough job. It’s a job and board members really don’t know what they’re getting into. They have to understand the risks that go along with health care, and understand the operations pretty well to be a governing board. We have had a phenomenal group in this community over many years that were willing to serve. And, this last board of directors had a tough decision to make, but I think they made a decision community members should recognize. We now, as part of such a huge system, will have ensured health care at a very high level for all the years to come.

It’s a special group of people willing to make a tough choice. That was hard, I know, for each of them to ask, do we want to be independent? Do we want to be part of a system? A tough choice. And they made a good choice. Had John McEvoy been here, he would have made that same choice, particularly when he saw what it would bring to the Casa Grande community.

GC LIVING: You said there were two things, and, I think I forgot the other.

Rona Curphy: Oh, the other thing is, we have a phenomenal group of employees who work at that facility. We had over 800 employees, and they stuck with this facility as we went through the transition. In the time period we said we were looking for a partner, and then found a partner, and then what we had to do in this massive transition. And you know, not everyone had to stay. We could have had people leave, but we didn’t.

Our directors have been phenomenal. It’s tough to make this type of a transition, but they were committed to these community members, and all the patients and people here. They wanted to see it work well. They’ve even come to me now and said, “Rona, if they need help at University, we’re willing to go down and help them transition,”They know what it’s like. So, we really have committed people who want to make this quality health care close to home for all citizens in the communities we serve.