Roosevelt General Hospital in Portales, New Mexico was awarded a Small Rural Hospital Transition (SRHT) grant for the equivalent of $55,000 worth of financial consulting services last year. Consultants helped RGH to develop ten specific actions to improve the overall financial standing of the local hospital. “Based on the progress RGH has made to date, they choose to highlight RGH among all rural hospitals,” stated Kaye Green, CEO.

Roosevelt General Hospital (RGH) is a 24-bed, not-for-profit, Short Term Acute Care (STAC) hospital, providing acute care, emergency medicine, surgery, interventional pain management, imaging, rehabilitation, laboratory, and related outpatient ancillary services to the residents of Portales, New Mexico, Roosevelt County, and surrounding communities. RGH also provides primary and specialty care services through its owned and operated Hospital-Based Rural Health Clinic (HB-RHC) in Portales.

Matt Mendez and Lindsay Corcoran, consultants with Stroudwater Associates, worked with RGH in 2018 through the Small Rural Hospital Transition (SRHT) project on a Financial and Operational Assessment (FOA). Center staff spoke with Kaye Green, CEO; Jeanette Orrantia, Director of Marketing, Planning and PR; John Bridges, Chief of Ancillary & Support Services; and Mercedes Lopez, CNO, in January 2019 to discuss the implementation of the consultant recommendations in the first six months. Their progress brought to life their slogan, “We are dedicated to making a difference in people’s lives through exceptional patient care.”

Q: Tell us about the implementation of this project and what kinds of things you found to be successful.

A: RGH reported progress on all ten priorities. They completed a chargemaster review in August and updated charges in September. This had not been done in about ten years and they discovered they were actually charging below Medicare rates in a few areas, which means they were not covering the cost of care. They also changed the way they bill surgical services. They quickly started seeing significant returns, including an increase of $1.4 million in collections in the first four months after the update was completed. They have also implemented an estimator tool so that patients are aware of charges and are prepared to make payment or set up payment plans at the time of the procedure. They are using tablets to allow patients to check in online in the rural health clinic and make a payment at that time. They have seen an increase in payment from $7.20 to $9.50 per patient which is positively impacting cash on hand. They hired a second financial counselor to minimize bad debt and help patients to create payment plans.

RGH is presently expanding services to a local market. Space has been leased and renovation is underway in preparation for an April 2019 start date. Attempts to expand in the area had not gone well in the past so RGH was very intentional in the way they approached it. They are starting with primary care including a physician and nurse practitioner. Both are known to provide exceptional patient experiences. They hope to offer Saturday services in the future, and plan to evaluate the need for pain management, endocrine and behavioral health. Physical Therapy & Rehabilitation services continue to be a shining star with great patient and employee satisfaction. To build on their success, they are also expanding into new services to enhance wound care and soft tissue therapies.

RGH has made surgical service improvements and expanded ophthalmology services to weekly, increasing cases from 5-7 every other week to 14-16 every week. They continue to consider the addition of other services such as orthopedics and podiatry however this would require the expansion of operating rooms (OR). A recently hired OR director increased throughput and as a result, pain management is up to 25 cases per OR day, shifts are staggered to decrease overtime, par levels are corrected, and the OR team completes cases more efficiently. They are also in the process of implementing more efficient OR and anesthesia call schedules.

While still researching productivity tools appropriate for their organization, some departments are implementing their own tools during this time. Focus on reducing overtime has already resulted in a decrease from 650 hours to 450 hours.

RGH implemented an emergency department (ED) redirect program in August and September. They redeveloped forms, educated staff, held open appointments in the clinic for redirect, and visited another hospital that was doing it well. They report a 20% reduction of non-acute patients that have been redirected to the clinic. They are also receiving positive feedback on patient experience surveys and reducing costs for non-acutely ill patients.

RGH is preparing to admit their first swing bed patient in March or April. They plan to conduct a pilot of this program before launching a full program. They will assess cost benefit with the hope to break even or generate additional revenue, while keeping patients closer to their home. They believe this program will also help to stabilize nurse staffing. Their discharge coordinator will reach out to two biggest referral sources to market the program once up and running.

RGH continues to increase chronic care management with the goal of reducing readmission rates for patients with Chronic Obstructive Pulmonary Disease, or COPD. They have worked closely with their Accountable Care Organization (ACO) on this and are adding more patients into this program. They have added behavioral health as another population to better impact the chronic care management of this population. They recently hired two more behavioral health providers and an additional nurse.

Q: What are the ways this project has impacted your hospital culture?

A: Non-measurable impact includes:

• Better teamwork across departments toward common goals
• Increased focus on growth and expanding market share instead of just cutting costs
• More consideration of “what more can we do?”
• More collaboration with other entities and looking for more opportunities
• Focus on staying at the forefront of healthcare trends and improvements

Q: Lastly, how do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?

A: “We were further down this road than some because we were part of an ACO. The project helped us to sharpen our focus on keeping people healthy through annual wellness visits, better chronic care management and reducing readmission rates.”