Hospital addresses Critical Access designation

Hospital board members, staff, commissioners and community educated on administration's future plans

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By JOSH NICHOLS
Daily Press writer
Education is the key to support. Questions, concerns and motives were first on the priority list at the Critical Access meeting at The Memorial Hospital on Monday night.
Hospital board members, hospital staff, county commissioners and members of the Visiting Nurse Association staff were educated on why the hospital administration is considering becoming a Critical Access Hospital.
"Our focus is to talk about the opportunity our community has to reclassify our hospital," hospital administrator Randy Phelps, said.
The purpose was served with one concerned individual.
Dr. David James said he was convinced of the benefits of going critical access after a presentation by Carol Davis from Quorum Health Resources consulting services.
"I had a lot of initial concerns," Dr. James said. "The more I've been educated, the more I've come to the side of supporting it."
Phelps said the hospital administration's reason for taking interest in becoming Critical Access is simple.
"A $950,000 improvement in net income is what made us extend our interest in this," he said.
The money Phelps spoke of would come in the form of cost-based reimbursement to the hospital for Medicare patients if the hospital chose to go Critical Access.
In a presentation that lasted more than an hour, Davis outlined what was learned in a study that was conducted compliments of a $25,000 grant by the state of Colorado.
First, Davis outlined how TMH fit into the different qualification categories.
In order to be a Critical Access Hospital, TMH must:
Be a rural hospital at least 35 miles from another hospital.
Be currently participating in Medicare.
Be providing year round 24-hour emergency room service.
Have an annualized length of stay of less than four nights.
Currently, TMH fits all requirements.
In the study, Quorum had to speculate what the numbers would be in the future.
Three scenarios were developed using different estimates of population growth, how many people would be needing inpatient care and the market share, meaning what percentage of people in the community will use TMH.
Drawing from the three scenarios, one recommendation made by Davis was that the hospital needs to continue to work to facilitate timely discharges of patients.
To curb the concern that patients would possibly be prematurely released to to accommodate the average patient stay of four days, audience member Dr. Allan Reishus contributed his opinion on the issue.
He said when a patient comes into the hospital, the staff already looks at how long the patient will need to stay in the hospital and if it is viable to move them to a nursing home or other care center.
"It's really a team effort between doctors and planners," he said. "We'll be looking right away at where they can go. We're doing that now and it will continue."
Phelps agreed that planning for discharge starts at the admission of a patient, and said patients are not prematurely discharged from TMH.
"Only twice in my tenure have people wanted to stay when the agreement was made that he or she should go home," he said.
The study conducted by Quorum also involved interviewing three other hospitals similar in size and demographics to TMH that have been Critical Access for six months.
Davis said in those interviews, she learned that the decision to go critical access was financially driven for all three.
One hospital was on the verge of shutting down, but was able to keep its doors open as a result of its Critical Access status.
No services have been reduced and no patients have been diverted at any of the hospitals, she said.
In the interviews, Davis also asked what the community perception was when a hospital went critical access, and no hospital reported a feeling in the community of being second rate.
Davis said her conclusion to the study is that going Critical Access would be of benefit to the community.
"Based on the information we've looked at it is very favorable for this community," Davis said. "I'm not seeing any reason not to do it."
Rob Riordin, senior consultant with Quorum, also spoke briefly.
In dealing with hospitals wanting to go Critical Access in the past, he said, there has been times when he has advised hospitals not to do so.
But TMH is not one of those hospitals.
As far as reimbursement assessments he has made based on the proposed designation, he said, "These are some of the largest figures I've seen in hospitals I've been dealing with who want to go Critical Access."
The information provided convinced Dr. James.
He had praise for the way the administration is presenting the information to the hospital staff.
"These guys are doing it right," he said. "I was originally ready to fight it because I had not yet gone through the education process."
He said patient care would not be affected by going Critical Access.
"What it comes down to," he said, "is patient care will be hurt the most if you can't keep the doors to the hospital open."
One motivating factor in becoming Critical Access is funding for a new hospital, but Phelps said Critical access would be ideal for TMH even if a new hospital were not being considered.
"When you're looking at bringing in a million dollars a year it is good for the community," Phelps said. "The next step is to look at the figures and see how much hospital that buys us."
He said a plan will be put in place to talk to the community in December, January and February if the final decision is to go Critical Access and build a hospital.
"My goal is to figure out a way to make this work without additional tax support," he said.

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