Board hears results from Health Needs Assessment

At the June Hot Springs Health (HSH) board meeting held in their conference room, Verlene Luna gave the quality report and said, "Part of our community health needs assessment really played into our strategic plan. Our growth globally has three main themes: mental health & substance abuse; chronic disease prevention, medicine, and education; and access to health care." Luna provided an update on what they have been doing so far.

Regarding mental health & substance abuse, Luna said that they will, "Explore initiating a Medication-Assisted Treatment (MAT) program in the chronic care management population to start the program and expand to other populations thereafter. Medication Assisted Treatment is the use of medications, in combination with counseling and other therapeutic techniques, to provide a 'whole patient' approach to the treatment of substance use disorders."

Luna added, "There are nice things about having residents as they bring up a lot of passion and a willingness to do research and help us with particular quality projects." One of the RTT participants, Dr. Kellen Klubben, has expressed interest in this program and will look at a scientific, research evidence-based methodology to be able to research this subject and be able to bring it to HSH and also get credit.

Not only that, Luna added, "Part of this also is exploring the use of a psychiatric nurse practitioner. I'm also working on bringing together a proposal for that, and more information will be coming so that the psychiatric nurse practitioner will be able to prescribe medications and do a lot of things to help with that whole-person approach...Also under mental health is improving access and awareness of mental health services for the care management population, using collaborative care management and utilizing the care management program, which is very robust in our area...I just presented a proposal for hiring a licensed clinical social worker for the rural health model and also under our clinics. We just wanted to take a look at what types of services they would be able to provide to that collaborative care model."

Regarding chronic disease/prevention medicine and education, Luna said their first objective is to leverage the existing care management program to further assist patients with chronic disease. Luna said they submitted an HRSA grant to expand care management to follow the patient from swing bed to home and enroll in CCM with a focus on cardiac disease and utilizing community networks and volunteers. The four-year grant is $300,000 each year. Also, in this focus, they are hard-wiring the polypharmacy project into care coordination as a result of the current senior resident's project. They will also focus on all Medicare patients being discharged from acute, swing, and observation for enrollment into the CCM program and completing the TCM elements if enrolled.

The second was to train registered nurses in each of the clinics to complete an annual wellness visit for Medicare beneficiaries to establish patient care plans and develop a methodology to follow up and make sure the patient's care management plan is executed. 

The third was to further adopt and implement a team-based model of care to support stable registered nurse staffing in the clinics that allow RN's work at their highest level of licensure so that work can be offloaded from the physician and advanced practice providers to increase access

Luna also discussed they were able to maintain certification of their current rural health clinics and explore certification of Riverton and Shoshoni and then leverage HSH's Health Provider Shortage Area designation that offers improved student loan forgiveness to new hire physicians, nurse practitioners, and physician assistants.

Luna said RHC, Riverton, and Shoshoni received certification with a zero deficiency. Basin was recertified with zero deficiency for five years. They also integrated the Surgical Clinic into rural health clinics in Worland, Riverton, and Thermopolis. And they recertified for the HPSA loan forgiveness status for existing rural health clinics and are in the process of applying for new rural health clinics, in Riverton and Shoshoni. 

Regarding access to health care, Luna said they are seeking to retain existing and newly recruited medical providers by building and strengthening relationships and maintaining and promoting the rural track residency program. 

Dr. Megan Olsen is the first resident to complete the RTT and has accepted a full-time position to begin in October 2023. Dr. Olsen's quality project was selected as a poster presentation for the Power of Rural Conference and the International Rural Nursing Conference.  

CEO Scott Alwin said the Community Health Needs Assessment CHNA is available on the HSH website under the About Us tab. Alwin added, "What we're doing now is we're just integrating it into the strategic plan so that under the appropriate areas that get tied to whatever the item is, then they can get carried out and actually lived out. And then in three years, we will be able to show the progress we made compared to historically...The community assessment is going to be on a quarterly rotation, just like compliance and quality is."

CEO Scott Alwin introduced new staff to the board. Haley Keith is the new pharmacy director who is from Worland and has five years of previous experience at Walgreens. Brianna Muller, who is interested in going to college for nursing, and Savanna Nelson, who is interested in becoming a surgical nurse, are two new summer interns. Alwin also presented Mya McKie, who is earning her associate's degree as a medical lab technician. 

Alwin also presented a plaque in recognition of Ron Jurovich. It said, "With greatest appreciation, we hereby present Ron Jurovich for your unwavering support and unrelenting guidance that helped in leading our path to success. You're being honored with much appreciation and gratitude for your more than 30 years of service to Hot Springs Heath."

Dr. Mattson Mathey gave the medical staff report and said that CFO Kevin Benson has now presented clinic financial information to their team. Mathey added, "I think it will be a good thing for us to keep our eye on understanding Hot Springs Health overall." Mathey went on and said that the informatics and IT teams have been helping troubleshoot with their clinic server and that the Cerner merge continues. He added, "We expect that to be a learning evolution for a number of months." 

Mathey also said they will be reporting on the Rural Training Track (RTT) each month to keep people up to date on it. At the time of the meeting was Dr. Megan Olson's last week as a resident physician at HSH. She will be graduating and then joining HSH in October as one of their attending providers. Mathey said, "She's a perfect example of the success of that program [RTT]." Dr. Kellen Klubben will start his third year as a resident. A second-year resident, Dr. Phillip Gard, a Riverton native, will be joining HSH. He spent his first-year residency in Casper. Also during the medical staff meeting, they discussed ICU utilization, outside practitioner policies, other policies, and labs. 

Regarding COVID, Dr. Mathey said, "We're all very enthusiastic about not testing all of our admit for COVID, only those who are symptomatic or exposed, everybody will still have a screening process they go through verbally to see if they warrant testing, but not every admit across the board will be swabbed for COVID anymore."

During board education, CEO Alwin discussed the need for board leadership succession planning and said, "It should always be at the forefront of our minds because things can change." Alwin said that as the board thinks about that planning, "What are some of the skills or attributes or competencies that we would like to see on our board and our leaders here on our board possess?" Some of the board's answers were that a new member has financial skills, previously ran a business, or comes from a teaching background or a medical background. Chairman Dr. Bill Williams added that a new board member should come, "with the right agenda, which is to serve the community and serve the hospital and not some personal agenda or ax to grind. They've got to have the best thing for the hospital and the community. It has to be at the forefront."

Alwin presented to the board a trustee candidate assessment form, a self-assessment where they can examine their gifts, talents, strengths, and opportunities, as well as weak points to evaluate from a self-reflection. Alwin also asked the board do they want to spend more time on their education. He said, "That might help us with determining the right folks to pursue in the future for becoming members of the board."

In the CEO report, Scott Alwin said they are working with Survey Solutions now and will transition into their partnership on July 1. Alwin said, "They'll be initiating a new methodology with our surveys." On June 6, they had the MQSA or the Mammography Quality Standards Act, which is an FDA inspection for examining their mammography unit, which they passed. Under quality, HSH had the Clinical Laboratory Improvement Amendments Survey of their lab department. HSH also has received the ARPA grant funding contract, which they have reviewed, signed, and sent back to the State of Wyoming. Additionally, Alwin said they have drafted a professional services agreement with Premier Bone and Joint. Also, HSH will hold regular town hall meetings for staff to ask questions and receive updates. 

CFO Kevin Benson gave the financial report and said that they had 92 surgeries, which was up from about 67, "a huge increase... It just seems like all of our departments have been busy exceeding their revenue budget." HSH has $1.8 million in revenue, which they exceeded in their budget by $600,000. 

Benson continued and said, "It seems like we have arrested the increase in days of accounts receivable. For the last two months, it is starting to creep downwards, not as fast as I'd like, but at least we're trending in the right direction. And then in association with that, our days cash on hand have also been stabilized, and I have seen a tick up as well."

HSH will also have an audit performed on its Medicare cost report in the fiscal year 2020. Benson and the other staff were not present at that time. However, the previous staff who were present and prepared the cost report will provide some support to Benson for the audit. 

Regarding the employee retention credit, Benson said, "An application had been filed on behalf of Hot Springs Health to participate in that program, but was denied at that time. We were denied because we were a governmental agency. Apparently, under the Biden administration, some of the rules have been changed. And so we may qualify at this point. We're using a firm that we actually got in touch with from Health Tech and this firm has had success with a couple of other facilities with Health Tech. And so we're going to pursue that application."

Benson had some action items for the board.

The board voted and passed the approval to have the public hearing for the 2023-2024 budget be held on July 18 at 5 p.m. It was noted in the meeting that no one from the public appeared last year to give comments or ask questions. The board also voted and passed the approval of the fiscal year 2023 Amended Budget. In the amended budget, they will exceed their operating budget, and the overage will be appropriated and authorized. There will be no exchange of funds. This amended budget was required by the county and will be presented to the county as information. 

John Gibbel gave the marketing report and said they live-streamed the flag-raising ceremony on June 14. Some of the participants were the Patriot Riders, the local VFW, and Austin Krueger of Lander, who helped put it on. Gibbel said he is also working with the hospital's foundation and created some flyers for their mentoring program. Gibbel reported he attended a couple of baby showers, one in Riverton, and the other in Thermopolis. He said, "It's kind of fun to see the parents who come by who say, 'We'll be seeing you in a month or two months."