NRMC to focus on partnerships and technology amid cuts and changes

Saturday, January 25, 2014

Nevada Daily Mail

"A new normal" is what Nevada Regional Medical Center CEO Judy Feuquay has called recent changes and ongoing assessments to the hospital.

That normal has included a staff reduction of 11 percent and evaluations of all patient services, a process that is still ongoing, with no definitive end in sight. The process, called "right-sizing," is expected to relieve some of the financial burden administrators say is due to a cocktail of money problems: declining federal reimbursements for Medicare and Medicaid, charity services and patients' failure to pay.

Feuquay said the failure of Missouri's Medicaid expansion to pass in 2013 has caused an additional burden to the hospital, as it searches for ways to work with shrinking revenue.

Last fall, hospital administrators began evaluating the facility's needs and issues, meanwhile, developing a strategic plan for alleviating many of the financial problems. That plan included layoffs -- which began in January -- and reconsideration of every hospital department and service. Feuquay said there has been push back amid these changes, but that the hospital staff size must reflect the demand on services.

At the center of the medical center's woes is the necessity of providing services to Nevada and Vernon County residents, who otherwise may have to drive as far as Joplin or Kansas City to receive medical attention. Hospital administrators have several ideas for keeping patients -- both current and future -- walking through the doors, regardless of current changes.

Digitizing the facilities

Feuquay said NRMC is undergoing a transition to a digital system, which will allow physicians and hospital personnel to easily access and update patient information. A digital charting system will cut down on the amount of time hospital workers will need to file items, or research a patient's prior health issues.

The computer system, which was purchased from Cerner in July 2013, hasn't been fully utilized. Prior to purchasing the system, the hospital had a seven-year-old electronic system, but emphasis on cutting down on time spent keeping records encouraged a better solution.

Feuquay said that between busy employee schedules, patient care and the wave of changes at the top of this year, it's been hectic, trying to get staff trained.

This month, staff is undergoing training to learn how to best use the system, and hospital administrators are considering all of the facility's digital needs. Because the system has a variety of components, Feuquay said it will take time to learn everything the system can do.

"We haven't even scratched the surface for what it can do," she said.

According to Feuquay, an additional perk to the computerized records system is that patients will be able to access their own records through an online portal. Doctors will also be able to see patient information and can compare notes with other physicians a patient may have seen. Specialists will be able to see a patient's previous medical history and can pick up treatment where other doctors left off.

From this year on, incoming patients will have information updated into the computer system, with older information added when necessary. There will not be a focus on adding all old information to the system and paper files will still be in use, for an unknown amount of time.

During the assessment process, Feuquay said the hospital is currently considering expansion of its Telehealth and Telemedicine programs. These systems allow Vernon County patients to meet with doctors and specialists from partnering hospitals, via webcam -- similar to chat programs like Skype or Facetime, but with specialized cameras, for increased clarity.

Feuquay said expanding these programs would ensure that patients are still able to see a variety of specialists, even in the event that the related department was cut from the hospital.

Stronger partnerships, more visits

Tertiary partnerships -- or alliances between hospitals to offer services -- are some of the largest goals NRMC is looking to expand. Feuquay said administrators are looking to enhance the relationship the hospital has with medical centers in Kansas City and Joplin.

While NRMC already sends patients to different hospitals for services beyond what it can offer, creating a better working relationship between regional facilities would allow for additional healthcare options. While Nevada's medical center already supports clinics and regular meetings with specialists, better partnerships could allow more physicians to meet regularly with Vernon County patients. These traveling specialists could make the trip from other hospitals for day visits in the area.

Feuquay said clinics are included in the current assessment process, and that they are also being evaluated for ways to become more cost-efficient.

Judith Herstein, director of community relations at NRMC, said marketing the hospital and its services is a necessity to increase patient volume. While some service departments may be removed from the facility, others will be marketed for community members to use.

One of those services includes two recently acquired hyperbaric chambers. Purchased March 2013, the two units came with a total price of $200,000. Feuquay said that encouraging the use of the chambers may bring in additional revenue and is a goal for the medical center.

What's next

Feuquay said that while changes are in the works, many upcoming modifications cannot be discussed until the hospital board meets on Tuesday, Jan. 28. In the meantime, many ideas for the next steps are solely suggestions, and nothing can be finalized until the hospital board's decision on the next steps.

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