Scores improve, but JPS faces more challenges

Paige DeHart had some long-held notions about Tarrant County’s John Peter Smith Hospital, and they weren’t good.

Before she got a call in August that her 18-year-old daughter, Hope, was in intensive care at the county hospital, DeHart didn’t think she would want anyone to be treated at JPS — much less count on them to save Hope.

“I’ve lived in Fort Worth my whole life but I always thought of JPS as being a dump,” DeHart said.

In a matter of weeks, DeHart’s opinion dramatically changed. She said she believes her daughter’s recovery after being left for dead with a gunshot wound was a miracle, but DeHart also thinks her daughter was exactly where she needed to be.

“I know that is the best place to be if you have a traumatic injury,” DeHart said. “Granted, the old building needs remodeling, but when I drive by there and I see the building, I have a real sense of awe and respect for that place.”

JPS, Tarrant County’s only public hospital and only Level 1 Trauma Center, often treats patients with life-threatening injuries or those who have nowhere else to go. More than 6,000 employees work at the hospital campus on the near south side as well more than than 40 health centers across the county. JPS also has the county’s only psychiatric emergency center.

The hospital has improved wait times for the emergency room and for doctors’ appointments since Robert Earley took over as JPS Health Network’s chief executive officer in 2009. It also opened a new Heart and Vascular Care Center this year.

“We're not in that fearful state anymore because we’ve got a lot to show off now,” Earley said.

But JPS is at a crossroads in a rapidly changing medical landscape in Tarrant County.

Among the key issues:

▪ Hospital and county leaders still are pushing for a bond package to expand and improve the aging hospital. The bond proposal likely will be taken to voters next year but faced opposition last summer.

▪ JPS is trying to bring all its providers under one umbrella with the new Acclaim Physician Group, but the plan is making some doctors uneasy. JPS officials have said the move should improve patient care by placing all the providers under the same set of standards.

▪  At the same time, JPS must deal with a growing population. Emergency visits per day have increased from 223 in 2009 to 310 in 2014.

“I think JPS needs to be thinking about where its future is and how that overlays to the demographics of this community,” Earley said.

The Health Network also is trying to determine the impact of the new medical school announced in July by TCU and the University of North Texas Health Science Center. Earley views it as an opportunity to develop more homegrown doctors for Tarrant County.

‘Not the old-time JPS anymore’

While the number of emergency visits has grown, JPS wait times have dropped from 6.36 hours in April 2009 to 4.3 hours in July 2015. The number of days to get an appointment at clinics decreased from 60 days in March 2013 to 26 days in July 2015.

Those improvements bring JPS in line with the average wait times in emergency departments nationwide. A fact sheet by the American College of Emergency Physicians shows that the average length of time people spent in emergency departments nationwide was 4 hours and 7 minutes in 2009.

JPS also has fewer patients leaving the emergency department without being seen, dropping from 15 percent in April 2008 to 2.6 percent in July 2015.

Precinct 1 Commissioner Roy Brooks said JPS also has improved on its mission of treating the indigent.

“It's not the old-time JPS anymore,” Brooks said. “There's been a lot of progress made on a lot of different fronts.”

This year, the new Heart and Vascular Care Center opened, which ended the practice of transferring patients to other facilities for bypass surgeries and procedures. As recently as 2002, JPS still sent some patients to Galveston, where they had a contract for open-heart surgeries.

The new center in the expanded east pavilion includes a cardiac catheterization procedure room, an open heart procedure room and two minor procedure rooms for biopsies.

“When I first got to JPS five and a half years ago, we were outsourcing most of these things,” said Billy Dimas, a cardiac electrophysiologist.

“JPS essentially had a contract at Baylor,” Dimas said. “Lab times were difficult to get. Patients were sometimes uncomfortable going to a private hospital. We brought everyone back in-house, where it’s easier, cheaper and more efficient.”

Need for bond

Despite the new center and some remodeling, Earley said JPS facilities are lacking in some areas.

On a recent tour, Earley showed one room in the hospital that contains three beds to highlight the need for improvements.

Overall, JPS has 104 rooms with two beds and 246 rooms with one bed. Earley said all patients deserve a private room for a variety of reasons, including infection control and to comply with federal HIPAA laws.

Also, the county’s 10th-floor emergency psychiatric ward is inconveniently located far from the ground-floor emergency department, posing a safety risk as patients are transferred.

“We have the only emergency psych facility in town,” Earley said. “It's a challenging place, and it's in the wrong place in the facility.”

Those are just some of the examples Earley gives as reason for a bond election, possibly in November 2016.

“The last time we asked for any level of voter participation was 30 years ago, and I think it's important that we begin to think about that,” Earley said.

The $809 million bond package rolled out last summer included a 10-story patient tower and a five-story psychiatric hospital that would increase capacity from 96 beds to 148. It remains uncertain whether all those items would be included in a new bond proposal.

The initial plan met opposition during town hall meetings last summer from Tea Party conservatives and Tarrant County's GOP executive committee. More than 650 people signed a petition asking that the package not be put on the ballot. Tarrant County officials decided to wait.

“The facilities need improvement,” said the Rev. Ralph Waldo Emerson Jr., chairman of the Tarrant County Hospital District Board of Managers, which oversees JPS. “It is hoped that we will have an election next year. I will be advocating and pushing that movement.”

Precinct 2 County Commissioner Andy Nguyen, who has questioned JPS’s ability to pay down debt, said he understands new facilities are needed.

“I think JPS facilities are over 50 years old and need to be renovated,” Nguyen said. “Some of the technologies are old and antiquated, and there are issues, especially with infrastructure and the split layout of various facilities.”

When Tarrant County commissioners approved the Tarrant County Hospital District’s fiscal year 2016 budget in September, Nguyen was the lone dissenting vote. He still has questions.

“There needs to be a little more due diligence,” Nguyen said. “There are concerns. We need to at least allow the opposition to be heard and open up the process. Let’s work together to come up with a solution.”

Precinct 3 Commissioner Gary Fickes said county officials know JPS needs to expand to deal with the county’s growing population.

“The numbers have come close to doubling,” Fickes said. “You can't continue to do the same thing if you have twice as many patient encounters.”

But Fickes also wants more clarity from JPS officials.

“There were answers they couldn't provide, but I think given the proper amount of time, they’ll be able to take care of that in the future,” Fickes said.

Physician group

JPS is also working to bring all its providers into the Acclaim Physician group, which they hope to have operating by the end of March. JPS now has 18 physician groups with 19 separate contracts.

Acclaim is designed to make service more efficient, providing the same incentives and standards for all doctors. JPS officials have said it should improve patient outcomes.

But the move to a single entity makes some doctors nervous.

In a Nov. 10 letter to the Tarrant County Hospital District Board of Managers, the providers of JPS Physician Group asked for more time.

“Our concerns persist and many questions remain unanswered,” the JPS Physician Group letter said.

Originally, the University of North Texas Health Science Center doctors were intended to be part of Acclaim. Now, they will be assigned to Acclaim and paid through its compensation structure but will not be members, said Michael Hicks, the UNT Health Science Center executive vice president for clinical affairs and the interim chief executive officer of Acclaim.

The JPS Physician Group was originally scheduled to be one of the first providers to go under Acclaim on Jan.1, but the group’s current contract has been extended.

“Initially, Acclaim was presented as a partnership between UNT and JPS,” the JPS Physician Group letter said. “Since UNT is no longer involved as a member, the difference between JPSPG and Acclaim is not clear to us.”

Nguyen, a Tarrant County commissioner, has concerns about the way physicians are being treated.

“A trusting partnership with physicians is one of the key factors in operating an effective healthcare network,” Nguyen said. “That relationship is deteriorating.”

Earley praised

While JPS faces a changing landscape, Earley’s leadership is earning praise.

Emerson said he has “instilled a different view of JPS to the exterior community and he’s done a great job of getting people to have a passionate, possessive feeling about JPS.”

But Nguyen said Earley can’t steer the ship alone.

“I think Robert Earley has great personal skill,” Nguyen said. “He understands politics and how to cultivate relationships with the right people, but healthcare is a very complex business, not only with regulation but also dealing with intricacies of operating such an entity. It will take awhile longer to catch up in some of those areas, and that’s why we need to bring in experts in the operation of the hospital to help Mr. Earley.”

This story was originally published November 16, 2015 at 4:53 PM with the headline "Scores improve, but JPS faces more challenges."