Chronicling the next phase in our "Save St. Andrews" Hospital Project:
After gathering the "customer requirements" of the people on the Boothbay, ME peninsula, our Community Hospital Working Group embarked on a series of hospital site visits to learn more about how other small rural hospitals manage to serve their communities profitably.
Our group of local volunteers was organized by Maine State Representative Bruce MacDonald and includes:
- Dorothy Hurt, Emergency room RN and former Head of Quality at a Nebraska Community Hospital (who organized all the site visits)
- Sandra Rumery, Retired Mental Health Nurse Manager, Commonwealth of MA & Consultant to ER Clinical Team
- Margaret Perritt, Retired Exec. Dir. of 501(c)3 in Virginia and former Asst. Dean of Women, Virginia Commonwealth University
- Fran McBrearty, mediator with Maine Attorney General’s office and former Program Director for IT integration at Cisco Systems
- Dan Jameson, mediator with Maine Attorney General’s office and former HR Director at Raytheon
- Jane B. Good, small business owner, Southport and former organizer of multi-year peninsula-wide programs to prevent substance abuse and domestic violence
- Tom Hagan, CEO Actioneer, Inc. (software company), and former Chairman of the Board of a 501(c)3 in Massachusetts
- Dr. Judy Stone, Infectious Disease Specialist, Board-Certified in internal medicine, author of Conducting Clinical Research
- Peggy Pinkham, Consultant, Maine Quality Counts, and Critical Access Hospitals organization, and former CEO, St. Andrews CEO
- Yours truly...
As you can see, our research team is comprised of a group of pretty impressive people, each of whom brings years of experience and a unique perspective to these meetings.
Gathering Best Practices from Similar Hospitals
In the course of 2 months, we visited with the management teams of 8 different Critical Access Hospital, mostly face-to-face, but a couple via conference calls:
As of today, we have visited with the Exec Teams from 8 Critical Access Hospitals. Each team spent from 1 to 3 hrs. with us. The hospitals we visited with to-date are:
- Blue Hill Memorial
- CA Dean in Greenville
- Down East Community Hospital in Machias
- Houlton Regional Hospital
- Mayo Regional in Dover-Foxcroft
- Penobscot Valley in Lincoln (65% on govt. assistance)
- Redington-Fairview in Skowhegan
- Sebasticook in Pittsfield
(We still have a few more to go--there are 16 in all in the State of Maine, including ours, which is the only one whose future is in peril). Of the ones we have visited, CA Dean in Greenville is most like ours, in that it serves a very small community during the wintertime, which triples during the summer season. Blue Hill Memorial is also very similar. Like us, it's a small coastal community with a large seasonal population.
Warm, Candid Reception: All of the management teams we have met with have been very open, warm and helpful. They have been very generous with their time and expertise and have offered to help in any way they can.
Here are some of the highlights of our findings to-date:
Business Strategies are Driven By Reimbursement
Unfortunately MUCH of the discussion at each hospital centers around reimbursement. Not what services do patients and community members most need, but what services can you get reimbursed for! This is a sad commentary on the state of healthcare in this country!
The Typical Reimbursement Mix across the Hospitals we've met with:
- Medicare 47%
- MaineCare (Medicaid) 22%
- Commercial 18%
- Payment Plans: 6%
- Free Care: 7%
- ER staffed at night in winter by RN/PA with MD on call [CA Dean];
- Use Telemedicine for Trauma and Psych –This is working well at a number of hospitals.
- Add 15 Long-Term Nursing Patients -- Offer “nursing home services” within 1 wing, providing long-term care to patients needing skilled nursing. Reimbursed by MaineCare @ $185/night (negotiated). Private Pay patients also accepted (same rate). (CA Dean)
- Aggressively recruit Patients from other facilities all over the state by proactively informing Case Managers (MaineCare) about open beds on a daily basis; Evaluate and accept/reject each case within 60 minutes. (CA Dean, Blue Hill)
- Have Nurses and CNAs work flexibly across nursing and acute care patients (CA Dean)
- Reinstate Operating Room and Outpatient Surgeries Schedule 1 day/week and increase to 2 or 3 days as needed. (1 day sterile; 1 day clean/scope)—Orthopedic surgeries and minor general surgery—Gall Bladder, Gynecological, Appendectomies, Hernias, and of course, colonoscopies – (CA Dean does 3 days/week most weeks)
- 24x7 Lab: Reinstate the Lab and aggressively recruit lab work from all over the state, including by visiting patients in nearby nursing homes with a physician and phlebotomist to collect fluids for testing.
Diagnostic Imaging Services on site
- Infusion Center – Establish an Infusion Center and aggressively recruit patients who need convenient infusion/transfusion services (CA Dean)
- Chemotherapy – Provide chemotherapy with part-time oncologist and telemedicine support (Houlton, Redington-Fairview; Blue Hill)
- Become a Rural Health Clinic: Turn our Family Care facility into a RHC for Family Care, Pediatrics, OB/Gynecology, Gerontology, Internal medicine (need to have an avg. of 4,200 office visits per year per physician; 2,400/yr for mid-level PA’s to qualify as a Rural Health Clinic); Receive total cost-based reimbursement from Medicare/Medicaid. [CA Dean, Houlton, Mayo]
- Proactively Recruit and Welcome Seasonal Patients for monitoring of chronic conditions and routine labs and imaging and visits by Local Physicians (CA Dean, Blue Hill)
- Specialist Clinics and Visiting Docs for ENT, Urology, Cardiology, Oncology, Neurology, Endocrinology, Psychiatry – needs separate office space/PA support for reimbursement purposes (not part of RHC or CAH)
- Provide Telemedicine consults for patients/PA’s with specialists, including psychiatry, oncology, etc.
- Provide Walk-In Clinics at the existing Rural Health Center/Family Care Center--If these are done as 7 to 9 am office visits by NP’s, PA’s and physicians, they will count towards productivity goals per Family Care practice (CA Dean)
- Provide Diabetes Outreach/Cardiac Rehab/Pulmonary Rehab: Services provided by nurses and therapists. Cost-reimbursed for Medicare patients. (Redington-Fairview)
- Wellness Program for Residents of the Peninsula: Includes 1 or 2x/year health screening visits with a nurse; case management; incentives for exercising, good dietary and wellness practices, and proactive tests—prevent and reduce chronic conditions. (Houlton)
- Mental Health Program Phase 1: Proactive outreach through the Y for youth with a young counselor; Use Telemedicine for Psychiatric Consults (Mayo, others)
- Mental Health Program Phase 2: Later: Add a special wing/with mental health beds for both local use and to provide stabilization/care for mental health patients in other parts of Maine. (Mayo suggestion)
- Substance Abuse/Rehab Program
- Veterans’ Clinic (Houlton)
For the complete report, see:
See also, the write-up in our local paper, The Boothbay Register, (which criticized our approach, claiming that we hadn't met with any of the execs from the hospitals that belong to the group that wants to shut our hospital down.)