One thing that community hospitals have in common—at least if they want to be successful in the years ahead—is a strong tie to the community. Most of these facilities exist because the community built them. That connection is what helps keep many of these small-town hospitals open amid declining reimbursement rates and the rising ranks of the uninsured. What the community thinks matters. And many communities place a high value on local autonomy because they are invested—either through taxes or donations—in the local hospital. They want to ensure that their hospital has their best interests at heart.
But maintaining independence is becoming increasingly difficult for smaller community hospitals. One of the biggest threats in today's market is increased competition from larger health systems that are expanding their reach into suburban and rural markets. This competition is forcing some community hospitals like Northern Hospital in Mount Airy, NC, and Hugh Chatham Hospital in Elkin, NC, to compete with larger hospital systems. Northern Hospital, which is spending $22 million to more than double its space for operating rooms and outpatient care, and Hugh Chatham, which is spending $41 million to increase capacity in its emergency room, are expanding their facilities so that they can treat more patients locally (complex cases will still be transferred to nearby tertiary systems).
Not all community hospitals have the resources to expand or modernize their facilities. Still, viewing a merger or affiliation with a large system as strictly a last resort may not be the best strategy. I've spoken to many hospital executives who say that independence is a state of mind. They maintain that it really doesn't matter if you are independent, partnered with a management company, affiliated with another hospital, or part of a hospital system, as long as you are meeting the needs of your community. What matters is that you have the resources required to update your facility, invest in new technologies, improve quality, or expand services.
If you can maintain independence and still meet the needs of your community, great. But if you are struggling financially and watching patient volumes slowly decline, you may want to think about joining or partnering with a health system sooner than later.
Not all partnerships are created equal. Some affiliations allow the community hospital to maintain a local board with reserve powers and independent decision making, while others do not. Waiting until you need a system to save your hospital from closing is not a good position to be in. It limits your choices and makes it more difficult to find a system that is a good fit for your facility and community.
Regardless of what option you choose to strengthen your hospital financially, experts contend, community support is a must. You need to maintain that connection to the community. Craft an elaborate communication strategy so that members of the community understand what is going on and why. And above all, try to build a consensus in the community that the path your hospital is taking is the best one.
Editor's note: This is my last column for HealthLeaders Media Community and Rural Hospital weekly. I'd like to thank all of the readers for the great feedback. I'll be taking over our leadership newsletter, HealthLeaders Media Corner Office, starting Friday. John Commins will be writing the Community and Rural Hospital eNewsletter.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
Seven months after the Centers for Medicare and Medicaid Services spiked the disease management-inspired Medicare Health Support (MHS) program, CMS announced last Thursday that a physician-run demonstration improved quality of care and saved money in the areas of congestive heart failure, coronary artery disease, and diabetes mellitus.
The 10 physician groups taking part in the Physician Group Practice (PGP) demonstration project earned $16.7 million in incentive payments and four of the groups earned an additional $13.8 million in performance payments.
Five of the physician groups also achieved benchmark quality performance on all 27 quality measures, and 10 of the groups achieved benchmark or target performance on at least 25 out of 27 quality markers.
"This CMS PGP demo project is a great example of large integrated delivery systems producing high quality of care while lowering costs," said James Lee, MD, who is spearheading the PGP project at Everett (WA) Clinic, during an American Medical Group Association teleconference last Thursday. "It is a great model for future American healthcare." If PGP is the future, does that mean DM and the Medicare Health Support (MHS) project are the past? By its actions this year, it seems CMS thinks so. "We are paying for better outcomes and we are getting higher quality and more value for the Medicare dollars," said Kerry Weems, acting administrator of CMS, in a prepared statement. "And these results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians."
CMS' announcement about PGP is in stark contrast to the organization's thoughts about the DM-inspired MHS project. Some of the biggest names in the DM world joined MHS to test the model in a sickly Medicare population.
CMS is ending MHS this year, citing disappointing results. DM advocates are displeased with the project's demise, how the end was announced—a FAQ file on CMS' Web site and no press release—and lack of specifics as to the program's failings and lessons learned.
I recently spoke to a CMS official about the MHS project and the person said the demonstration is just the latest DM project to fail in the Medicare population. The official said CMS is ending MHS because it did not see "significant impact on utilization of services and therefore on costs."
The fact that physician-led projects in the PGP are showing savings and higher quality while the DM project is being shelved shouldn't come as a surprise. Patients feel a greater connection and have more respect for their doctors than a faceless nurse on a phone.
But don't write DM's obituary just yet. There is still a place for DM and health management in healthcare. It's probably not in the remote nurse call center though. The PGP project, which is the first pay-for-performance initiative for physicians under the Medicare program, shows the importance of involving physicians in care. Many DM companies have avoided physician interaction and dealt strictly with the patient. This has created confused patients and miffed doctors.
There has been movement in the past year to change that model. More DM companies see the importance of having the face-to-face advocacy of a physician in the care process. There has been an added focus away from the call center program that reaches out to the chronically ill to health management and wellness programs that connect with everyone. In fact, DM's major industry organization, the Disease Management Association of America, even changed its name last September to DMAA: The Care Continuum Alliance because of the industry's changed focus.
The demise of the MHS project was bad news for DM, but innovative leaders have already moved beyond the nurse call center model of DM to one that includes physician offices.
Care coordination is the present and future, and the DM companies that lead the way will be the ones that flourish.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .
Note: You can sign up to receive Health Plan Insider, a free weekly e-newsletter designed to bring breaking news and analysis of important developments at health plans and other managed care organizations to your inbox.
The Nevada-based Dayton and Fernley Rural Mental Health offices are both scheduled for permanent closure by September. Both mental health offices have provided healthcare services for mental health treatment in the Dayton and Fernley areas, and their closure will leave a substantial void in the healthcare net of Lyon County. With rising gasoline costs and no available public transportation system, the closures will be even more difficult for clients, experts say.
One July weekend in Wise, VA, a huge annual medical and dental expedition was set up by Remote Area Medical, a nonprofit organization that provides basic medical and dental care to people in the world’s most inaccessible regions. This year, more than 1,800 volunteer doctors, dentists, nurses, and assistants descended on Wise, setting up enormous field-hospital-style tents in which they saw roughly 2,500 patients over the course of two and a half days. The Knoxville, TN-based Remote Area Medical runs about 15 similar clinics around the world every year, from Guyana to East Africa and rural parts of Appalachia, and the clinics underscore the healthcare dilemmas of the poorest Americans.
'Critical Access' Hospitals are given a federal designation that allows it to bill Medicare for 101% of its outpatient, inpatient, laboratory, physical therapy, and post-acute care costs. The critical access hospital program was designed to ensure access to emergency, primary, and acute care in rural areas across the country. In Kansas alone, almost all of the state's rural hospitals are now critical access hospitals, and many are prospering.
Although the hospital needs to establish itself as a center of excellence, the individual doctors are the most important element in hospital marketing, according to this posting from Anas' Weblog. When a doctor first starts working for a hospital, they will draw new patients largely from the pool of patients they have previously treated. But doctors need to work with hospital marketers to increase the size of that patient pool from the beginning, the author says.