An overhaul of Student Health Services

Less waiting time, easier access and better quality are what students should expect after the campus clinic completes an internal reorganization, University officials say.

Those results will spawn from a restructuring of Student Health Services (SHS), including layoffs, hiring and outsourcing its lab that could save hundreds of thousands of dollars.

SHS laid off five of its 10 registered nurses (RN), said director of SHS Diane Zanto, and replaced them with five medical assistants (MA).

Zanto said the remaining five RNs will function in specific roles: Two will assist patients who are “acutely ill” and need immediate care, one will manage and distribute immunizations, one will manage education and training, and one will serve as the nursing manager.

The savings amount to $130,000 annually based on the difference in salaries of RNs and MAs, Zanto said.

“An RN staff is much more expensive because they’re more educated and more skilled, and we really weren’t using them or at this point weren’t using them as skilled RNs,” Zanto said. “They were only functioning as MAs and it’s about half the salary.”

According to the clinic’s budget summary, the combined salaries for the laid-off RNs total $249,761.

Zanto said it wasn’t a good use of the Student Health Fee. This academic year, students paid an $8.60 health fee, which funds 75 to 80 percent of SHS’ total budget, which is about $7.8 million.

The clinic also receives funding through health insurance billing, Zanto said.

An MA is someone with only a few months of training who prepares the patient for a nurse practitioner (NP) or physician. An RN has a nursing degree, she said.

Zanto said that in the past, the process for getting care was timely – sometimes requiring students to first leave a message requesting an appointment, wait for someone to contact them and meet with an RN before even seeing a doctor.

“Sometimes it was actually a three-step process to actually get in to see a provider,” Zanto said. “They might call and leave a message. Then they might come in and see an RN and then the third time around they might actually get to see a doctor or a nurse practitioner.”

SHS has restructured to address that, though, eliminating a telephone operator and fielding six front desk schedulers. When students make an appointment, they will talk to an actual person, said Assistant Vice President of Health and Wellness Alan Kent.

SHS employs five physicians, four NPs and one physician assistant, Zanto said. The clinic hopes to hire two more NPs, including one who specializes in sports medicine.

The clinic plans to contract its lab by hiring an outside company that will use its own employees to staff SHS’ lab, Zanto said. She would not release the name of the company because the contract is not finalized.

“When that happens the service will be seamless,” Zanto said.

“Students won’t notice any difference in service delivery because when we established the parameters for the contract, it was to continue to the search as exactly as it was only to have that free-standing unit within our clinic,” she said.

This change is an estimated $100,000 in savings, Kent said. SHS employs six lab technicians for a combined salary of $219,377, according to the budget summary.

But the goal of the restructuring wasn’t to save money, Kent said. He said that was a secondary benefit.

“The benefit is twofold,” Kent said. “No. 1, students won’t have that middle step of seeing an RN, and then with the cost savings we’re able to hire more providers (doctors and NPs).”

All previous health care at SHS was primarily walk-in service, which led to a “great deal of dissatisfaction” because students had to wait long periods to receive care, Kent said.

This plan was put in place over the past year, he said, to improve students’ care and access and to bring SHS standards up to get nationally accredited.

SHS hopes to receive accreditation from the Accreditation Association for Ambulatory Health Care (AAAHC), Kent said.

“It’s the standard that most college health centers use for accreditation,” he said.

The process could take two to three years of preparation, Zanto said, in terms of getting policies and procedures in line, conducting quality-type studies and monitoring SHS providers to ensure their work meets high-quality standards.

To work toward that goal, SHS restructured the hierarchy of its employees. Two joint directors – one medical and one for business services – oversaw SHS operations, Kent said.

“We found to move the agenda forward, we needed to have one clear director in charge,” he said.

So, SHS hired Zanto in August.

Accreditation preparations began at the end of last year, Zanto said. SHS hopes to have a mock survey done next year and then apply for accreditation, with the hopes the process will be complete in 2011.

“You prefer to be accredited because it says an outside independent body has looked at your health care system to determine that it’s meeting top standard,” Kent said. “That’s our goal.”

SHS’ reorganization process will continue through next year at a time when it hopes to convert to an electronic health record through a partnership with USF Health, Zanto said.

Zanto said that would be a major “overhaul” amid all the changes.