Health Care

Chebra helping JFK’s bottom line by making EMS more efficient

From our print edition

By Anjalee Khemlani
Edison | November 14, 2017 at 12:43 pm

By Anjalee Khemlani
November 14, 2017 at 12:43 pm

Anjalee Khemlani/ROI-NJ
Jamie Chebra, left, and Ed Murawski know what it takes to run an efficient, millennial-friendly EMS operation. ¬

Anjalee Khemlani/ROI-NJ

Standing desks and numerous screens are two reasons JFK Health is so efficient.

Jamie Chebra, a self-proclaimed tech geek, has figured out how to cater to a millennial workforce and utilize data to save an Edison-based business money.

How much money? About $850,000 a year.

The story, however, is not about the bottom line.

The story is where he’s doing it: Chebra is the director of emergency management services at Edison-based JFK Health.

“The challenges of the millennial generation, while they are unique, I think they are overplayed,” Chebra said. “Managing a different generation is no different than being managed by a different generation. If you were to go to our previous generation, they would probably say the same things we say about millennials.”

Translating EMS jobs to the millennial generation isn’t as easily done.

The younger generation’s desire for the same fun work environment they see their counterparts enjoying in other industries — even though they work in an intense, life-saving field — is one of the reasons there is an ongoing shortage of employees in paramedic services.

That’s why Chebra has added more than just a few bells and whistles to the dispatch center for JFK’s EMS division.

Adjustable standing desks with, on average, five screens, and an under-desk elliptical are just a few examples. Then there’s the weekly meetings that can be attended remotely — this works for employees who are on the go in vehicles, who can dial in, and those not in the office who can attend via the webinar. And they get paid for attendance and engagement.

Chebra, 44, also prepares each employee with the ability to leave and seek a higher position elsewhere.

He said it’s a two-way street: He learns from the younger generation while they learn what they need to advance in life from him.

“People talk about the work-life balance of the millennial generation, but what I’ve noticed is there is no work-life, there is just work and life, it’s one thing,” Chebra said. “Being able to step outside what would be a rigid approach to management and become more customizable, with a human touch, and in touch with the generation, makes it easier to manage that group of people.”

***

Chebra has overseen a variety of changes since he came to JFK Health from Capital Health in 2012.

It began in 2011, when the senior management at JFK Health was convinced that the EMS department could be more than 60 full-time employees and two and a half vehicles.

“They were a rag-tag bunch of providers who were not very well regarded in the state,” Chebra said. “When we came on board, we started this mission of growing this department … from basically nothing.”

The goal was to be different than past employers and change things he had learned do not work.

“Today, we’ve grown from that 2.5-unit mom-and-pop style shop to, in our peak, I think we have 17 units on the road, and about 190 FTEs, with a vibrant communications control center, education center, advanced life support, basic life support, nurse call center, critical care and facility transport team,” he said. “And we work directly for the hospital.”

And, with his love of statistics and data, JFK’s EMS services has been garnering the attention of local government executives around the state, as well as other hospitals — including Atlantic Health, Virtua Health, Saint Clare’s in Denville and University Hospital in Newark.

The tracking of all the data continues to be a work in progress, and its overall financial benefit is yet to be fully analyzed.

But, incrementally, it has shown savings for the hospital.

The team achieves its lean operational strategy by utilizing a diagnostic program that tracks the various lines of service as well as stores metrics within each line.

For example, it tracks the units that service basic life support and advanced life support separately. It also monitors the coverage area, which includes Edison, Metuchen and South Plainfield.

The program looks 10 weeks forward and 10 weeks back and analyzes the probability of a high volume of calls, according to Edward Murawski, EMS communications manager. It is updated every 15 to 30 seconds.

Through that, management can schedule shifts and determine how many trucks need to be operating at which hours of the day.

On a recent Tuesday at around 11 a.m., there were seven active BLS trucks. By midnight, that number would drop to three, Murawski said.

The program can help determine the optimal location of a parked ambulance in order to respond within seven minutes, and that can change every 15 to 30 minutes based on the data.

“We have just the right amount of units on the road for the right amount of calls,” Murawski said. “So, we’re not wasting any money, but we’re also not overlooking and not providing care for the community.”

***

Data is being collected all the time. And in real time.

One of the screens in the command center has a number of speedometer-style gauges that continuously monitor response time to specific locations, the amount of time an ambulance takes to leave the emergency bay of a hospital, and other such metrics.

When one measured area is operating less than optimally (based on a scale from 0 to 100 percent), paramedics fill out written reports to explain what went wrong, and that is used in the data analysis to search for improvements, Murawski said.

In addition, the vitals and personal information of any patient that is being rushed to an emergency department is immediately transferred to the computers of nurses and physicians in the ER while the ambulance is still en route — cutting down administrative time, Chebra said.

“It pushes six figures, as far as efficiencies and savings,” Chebra said.

And, while Chebra has spearheaded these tech changes, he is the first to admit he doesn’t do it alone.

A lot of his ideas have come from attending trade shows and finding vendors who can build the platform and customize it.

“People who have good ideas but don’t have practical applications for their good ideas are the people I look for,” Chebra said.

But, for all the technical and data-driven changes he’s brought to the organization, Chebra has also transformed the way the division operates away from traditional personnel strategies.

Rather than paramedics sitting around all day in a truck waiting on calls, Chebra has found some use for the crews when the computer predicts a lull in action.

That’s when non-emergency transport — of people and lab kits — takes place. The trucks have driven as far as Cape May, Philadelphia and New York.

The runs can range from picking up patients for appointments, to transporting them to clinics or physicians and avoiding emergency room visits, as well as transporting lab kits to and from JFK, as well as to and from other hospitals in the region.

These help by avoiding costly visits or creating additional revenue for the hospital.

“We try to be a dual-edged department, where obviously there’s expectations of revenue generation for what we do,” Chebra said. “We’ve had a positive contribution margin of greater than seven figures for the five years that I’ve been here. We had between a 2 to 3 percent overall contribution margin to the bottom line. We try to run lean and efficient and save money where we can.”

The total added revenue is about $1.3 million last year alone, Chebra said.

And that’s with all the downward pressure from ever-changing payments from commercial insurers and government payers like Medicare and Medicaid.

“We’re feeling the pinch just like a lot of other hospitals are,” Chebra said. “We are still a hospital-based service. We are still subject to the same reimbursements.”

***

The cost savings of Chebra’s operation are not just for the hospital. Patients benefit, too.

The idea to use these trucks during less-active periods is key.

One of the other service lines for paramedic crews is acting as health care navigators and being an almost textbook definition of population health management.

If crews find themselves repeatedly responding to a specific patient’s home, they can help find the cause of the emergency in the patient’s home.

This can include cleaning the house or buying food, or figuring out which of their social service partners needs to be called to aid the patient or their family.

“I’ve had crews go out and buy cleaning supplies and clean their house for them,” Chebra said. “I’ve had crews buy food and put it in their refrigerator.”

Community paramedicine is a viable concept for avoiding ED readmissions, a closely watched metric by the Centers for Medicare and Medicaid Services.

“Because we are still living in a fee-for-service world, it’s difficult to convince somebody to prevent a fee-for-service admission by providing care in a nontraditional, nonscripted manner,” Chebra said. “It’s a big leap of faith for the hospital to have that level of trust in us.”

Another way the division is saving the hospital money is by partnering with cab services in Metuchen and Lyft — using both to schedule patient transportation when the patient doesn’t have another viable mode.

Using Lyft is the cheapest, since the hospital has created a software bridge and can schedule pickups ahead of time, as well as monitor the driver’s location and end up paying for the actual cost of the trip rather than a set contract amount, Chebra said.

The savings? About $150,000 in a year.

All said, the department has turned around from where it was five years ago, and hopes to continue its trend.

But Chebra and his team’s future is uncertain.

JFK Health has signed an agreement to merge with Hackensack Meridian Health, the state’s second-biggest system.

2017-11-16T14:44:50+00:00
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