Hospital board discusses mental health needs

At the May 30 Hot Springs Health board meeting held at their conference room, CEO Scott Alwin introduced new surgical director Tim Teson. Teson is originally from Cleveland, Ohio, and will oversee the operating rooms, ambulatory, infusions, and anesthesiology areas. Teson previously worked at MetroHealth, which is the county hospital Level-One trauma center.

In the medical staff report, Dr. Mattson Mathey said they updated their policies, such as not needing to wear masks when seeing Lab Well patients. Dr. Mathey added they went live with the Telestroke option and said, “It seems to be a pretty good service.” 

CEO Alwin held a discussion about their board education training at both the Wyoming Hospital Association Conference and the Billings Clinic Trustee Conference. Some subjects they covered were mental health issues and their treatments. Board member Jessica Benefiel noted from the Billings Clinic conference the massive increases in mental health needs even though they are operating at a loss in their service and they are committed to meeting the needs of patients. 

Chairman Dr. Bill Williams discussed the use of artificial intelligence and its being incorporated into medicine and said, “It’s pretty wonderful and pretty frightening. I think it will help a lot, but it’s going to take a lot of monitoring to make sure it doesn’t get corrupted.” 

Board member David Koerwitz discussed hospitals working with the legislature and working in trying to help with training and recruiting staff while there are shortages in finding nurses and healthcare workers. Koerwitz said he was “encouraged” by the focus on students pursuing nursing careers and keeping the students in the state instead of migrating elsewhere. 

One solution posed by board member Aimee Kay was to introduce to her middle school students the medical field through hospital tours to make them aware of possible career paths. Kay added that hospital medical staff could visit the school to meet the students. Kay also said she appreciated the scenarios presented in the possible credentialing physicians. CEO Alwin added that “We had to discuss, would you or would you not offer credentialing for that provider to come?” 

Alwin also discussed an economic analysis report where the Wyoming Hospital Association partnered with the University of Wyoming. The report analyzed the entire state and each county. Alwin said, “There’s a lot of good information in there…Housing was one of the big ones that they were going to be tackling here in the near future. And so just getting a basis of where we are with housing across the state and with each individual county. I look forward to seeing what that will look like.”

Alwin continued and said that he made a list for board orientation and previously talked to Kay. Alwin added, “We had a dialog about what you all need as a board, to have an orientation so that when you are new to the board, you have vital information that’s available to you so that it can help answer some of those questions.”

In the CEO report, Alwin said that they issued a leadership empowerment survey to their directors and executive team. “Basically, if you are a leader over other individuals in the organization, all of those employees had a chance to survey their leaders and provide feedback to their leaders. We really had a pretty good response rate of 84%. And then on a scale of 1 to 4, four being the highest, all of our leaders together averaged at 3.2. So look at that as a good opportunity to make good improvements. But yet we’re not on the bottom end. We’ve got some great leaders out there and then we have a chance to work at making some improvement for the next year.”

Alwin continued his report and said, “We are going to be receiving a little over $17,000 from the Wyoming Flex Grant program to help reimburse for the Community Health Needs Assessment (CHNA) that Health Tech helped us with. That will provide reimbursement for the cost of that.”

Regarding the CHNA, Alwin said, “In response to the Community Health Needs Assessment, our dialog during the strategic planning session and knowing that in our communities, we have a big need for assistance with behavioral health/mental health. I have been visiting with a gentleman from the psychiatric medical care who specializes in being able to provide resources to rural critical access hospitals.” 

Alwin provided the board in their packets with a sheet that presented three different models regarding this. One is an outpatient intensive therapy program designed for the older population. The other two are segments or virtual opportunities for their emergency department and for crises where the providers can get help from a psychiatrist to get feedback and opinions on what to do in their particular case with a patient. Additionally, they will help with logistics in identifying the appropriate location to go to if it is not appropriate to keep the patient in Thermopolis. 

CFO Kevin Benson gave the financial report and said, “We presented a preliminary version of the fiscal year budget for 2024. The way we prepare the budget is to basically take current operations, push them forward, and then make changes or make adjustments for known changes.”

“We implemented many of the measures from the margin improvement plan. And our goal was to get to a break-even in terms of our operating margin. Some of the revenue enhancements we’re seeing include a 5% price increase that will be effective July 1. We’re going to implement a five-star swing bed academy program. However, we don’t expect that to be really materialized until the second half of the fiscal year, where we’ll increase our swing bed utilization by one patient per day, and that will have a significant impact, about $600,000 of revenue that will be beneficial.”

CEO Alwin said regarding the 5 Star Swing Bed Growth Academy, “This is a 25-week rapid cycle improvement system that will be used to help improve our swing bed program. A Swing Bed admission offers our patients the opportunity to recuperate and recover here at Hot Springs Health over a longer period of time as compared to a normal acute care stay. Our goal is to enhance our swing bed program and offer more opportunity for our community and neighbors to recover here in Thermopolis after surgeries, injuries, and illnesses, and save travel to outlying hospitals.” CFO Benson continued his report and said, “We’ve seen some trends in our operating room with increased utilization from visiting physicians, particularly orthopedics. When we make changes or when we put in changes from the margin improvement plan, we were selective on what we wanted to put in, we only wanted to put in measures and initiatives that we knew would be realized. Not hopeful that this might happen, but that really is going to be realized in the fiscal year. The increased volumes that we are seeing in the OR have occurred over the last two months. It’s increased our revenue by about $100,000 per month. And so that’s a pretty significant impact.” 

Benson added, “On expense reductions, there were a number of staff positions that have been eliminated. That’s through attrition. I think there were six or seven positions at this point. So when we reevaluate the need for the opening and in these cases, we’ve been able to shift job duties around and not need to replace those positions. So that’s a savings of about at least half a million dollars.” 

Regarding some additional changes, Benson said, “We hired a coder, and this coder was in the Health Information Management Department that eliminated the need for all of our contract coding and that was worth about $80,000 a year. So that has been eliminated. And then, of course, our cost benefits with the implementation of Cerner, the monthly cost of the clinical work, will go away and that saves about another $70,000 a year. And so we were able to get to essentially a break-even operating margin. I know we want to be positive there, but I don’t think we can probably get there all at once. And that means the nonoperating revenue flows down into the net income bottom line, which currently shows almost $1.7 million. So a drastic change from where we’re currently operating to where I think we’re going to get to go. And I think we have a pretty good roadmap for that. Now, there were some measures in the margin improvement plan that we weren’t able to quantify, but we know that our savings are there. And so we’re going to be through the month of June tweaking a little bit and finalizing our budget, and then we’ll bring that to the board for approval at the end of June.”

CFO Benson also requested the board to take action and request from the county their full three-mill levy for the 2023-2024 year. The Hot Springs County Hospital District has the taxing authority of up to three mills and must request this from the county that authorized the mill level. The request must be done on an annual basis. The board voted and passed the approval to request the full three-mill levy. 

Risk Director Nina Landis gave the Quality report and said, “For the month of April, 30-day readmissions were down 4.7%, which is where we would like to see it. So hopefully it’ll stay there. The 12-month rolling average is 7.3%, so not super confident we reach our goal of 1.6%. We’ve only got two months to do that and I don’t know if we’re going to do it this year. We’re working on really with the clinic doing chronic care management and transitional care management. And the program is going really well. But unfortunately, we have a lot of elderly in our community, so we do see a lot of readmissions because of that. So we’re just doing what we can to try to reduce that. And then 72-hour returns. We’re up to 4.9%, which is a little higher than what we’ve seen. The 12-month average currently is 2.9%.”

CCO Dan Hemann gave the Compliance report and said that the compliance committee has been active for three months or longer. They wanted to reconduct a compliance survey with the help of Billings Clinic, and they also did a survey in 2022 with Health Tech. Hemann said, “We wanted to compare the two to just get those multiple perspectives actually as much as we can, which we’ve also done.” Hemann explained, “That survey showed that we’ve been doing a really good job kudos to Linda in H.R. with background checks, timely, getting on point, orientation timely as well. So we’re excited about that.” Hemann added that one of the items to work on is to make sure their reporting orientation is up to par, including the compliance piece of that as well.

Following the executive session, when the board returned to the public meeting, CEO Scott Alwin shared, “Hot Springs Health (HSH) now has a fully integrated medical record in the hospital and all five rural health and surgical clinics. Through our partnership with Billings Clinic, last week HSH had a full Go LIVE of the fully integrated medical record in all the clinics (Basin’s clinic actually went live in April). This offers multiple benefits for our patients and medical providers. For the patient, it ensures improved communication and transfer of information from all entities within our health system and reduces the chance for a medical error. Our providers and care team members can access all the patient information in one location, which improves safety, efficiency, and quality of care.” Also, following the Executive session, the board unanimously approved the Referral Incentive Policy, a new policy that provides an incentive for employees of HSH to refer friends, family, and colleagues to work at HSH.