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TCMH Begins DAISY Award to Recognize Extraordinary Nurses

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The DAISY Award-Logo-OLTexas County Memorial Hospital rolled out a new nurse recognition program, this week.  The DAISY (Diseases Attacking the Immune System) Award is an international recognition program that honors and celebrates the skilled and compassionate care provided by nurses every day.

The DAISY Award is part of the non-profit DAISY Foundation of Glen Ellen, CA.  The Foundation was established by the family of J. Patrick Barnes.  Patrick died at the age of 33 in late 1999 from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease.

The care Patrick and his family received from nurses while Patrick was ill and hospitalized inspired the DAISY Award as a way of thanking nurses for making a profound difference in the lives of their patients and patient families.

“When Patrick was critically ill, our family experienced first-hand the remarkable skill and care nurses provide patients every day and night. Yet these unsung heroes are seldom recognized for the super-human work they do,” Bonnie Barnes, President and Co-Founder of The DAISY Foundation, said.

In the past, TCMH has recognized one nurse annually with a “nurse of the year” award, and the DAISY Award program will replace the annual nursing honor.  TCMH hopes give out one DAISY Award to a nurse in the spring, and one DAISY Award to a nurse in the fall.

“The kind of work the nurses at TCMH are called on to do every day epitomizes the purpose of The DAISY Award,” Doretta Todd Willis, TCMH chief nursing officer, said.

TCMH has nurses that work in a variety of settings from hospital inpatient departments to clinics and home health and hospice services.

“All of our nursing staff has the opportunity to provide extraordinary care to our patients and their family members, and we hope that patients, family members, and visitors to our hospital will take the time to share their story and nominate a nurse for a DAISY award,” Todd Willis said.

The public is invited to submit personal experiences with TCMH nursing staff for the DAISY Award.

TCMH has DAISY Award nomination forms available in various departments around the hospital and clinics, including the front desk at the hospital.  The nomination form is also available online.

The nomination form asks for information about the specific act of extraordinary care that was experienced by the person making the nomination.  The person completing the form is also asked to provide contact information should more information about the act be needed.

DAISY awards will be evaluated twice annually, and one DAISY award will be given at each evaluation period.  All nurses that are nominated for a DAISY Award will receive recognition.

The nurse that receives the DAISY Award will be recognized at a public ceremony in his or her department.  The award recipient will also receive a special DAISY Award pin; a recognition certificate, and a hand-carved stone sculpture called “A Healer’s Touch”.

As part of the DAISY Award ceremony, the department will celebrate with cinnamon rolls.  During Patrick Barnes’ hospitalization, he requested Cinnabon cinnamon rolls, a personal favorite food.  He shared them with his nursing staff.  Today the DAISY Foundation includes cinnamon rolls with DAISY Award ceremonies in tribute to Barnes love of the sweet treat.

“We are proud to be among the healthcare organizations participating in the DAISY Award program,” Todd Willis said.  “It’s important that TCMH nurses know their work is highly valued, and The DAISY Foundation provides a way for us to do that.”

A complete listing of healthcare facilities that participate in the DAISY Award program can be found here.

For additional information about the DAISY Award, contact TCMH Nursing Administration at (417) 967-3311.

Cardiopulmonary Rehabilitation Program Gives Life Back to Area Patients

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The Cardiopulmonary Rehab Clinic at Texas County Memorial Hospital is located at the end of the East Wing of the hospital

The Cardiopulmonary Rehab Clinic at Texas County Memorial Hospital is located at the end of the East Wing of the hospital

The East Wing of the hospital is abuzz with activity these days.

The new Cardiopulmonary Rehabilitation Clinic is located in the four rooms at the end of a hospital that has been mostly quiet since the new medical surgical floor was built at Texas County Memorial Hospital.

Three former patient rooms and a staff break room on the wing have been converted into a waiting area, a reception area, and two treatment rooms for the patients in cardiac and pulmonary rehabilitation at TCMH.

Monday, Wednesday and Friday, the hallway hums with the sound of treadmills, recumbent cross training machines, hand pedaling machines, conversation, instruction and occasional laughter.    Tuesdays and Thursdays are a bit quieter in the East hallway as Matt Eskew, a respiratory therapist, and Kathy Carr, a registered nurse, complete patient charting and related paperwork and conduct new patient evaluations.

Cardiac rehabilitation has long been a part of the outpatient services available at TCMH, but with the addition of the pulmonary rehabilitation program, a complete clinical space was created for both programs.

Dr. Juan Mella, a board certified pulmonologist, joined TCMH in June 2016.  Mella asked TCMH to begin a pulmonary rehabilitation program to benefit area patients with lung disorders.

TCMH was able to make Mella’s request a reality with a $357,000 grant from Missouri Foundation for Health (MFH). The Missouri Foundation for Health is an independent philanthropic foundation dedicated to improving the health of the uninsured and underserved in the region.

The TCMH grant was part of $3,790,941 awarded by MFH to 10 different projects in one of three “special projects” funding cycles by MFH in 2016. The MFH grant funds are given to TCMH over a three year period.

The grant funds allow TCMH to cover wages for a full-time respiratory therapist, wages for a part-time administrative support staff member, equipment for the program, transportation expenses for some patients, patient counseling sessions, and smoking cessation products for some program participants.

A patient qualifies for the multi-disciplinary cardiopulmonary rehabilitation program following testing for lung disease.  The goal of the 12-week program is to help a patient improve lung function and activities of daily living.

Mella oversees the cardiopulmonary rehabilitation program and the patients taking part in the program.

Prior to beginning the cardiopulmonary rehabilitation program, the TCMH respiratory therapy department had statistics showing that over half the patients receiving pulmonary function tests at TCMH in the past year would qualify for a pulmonary rehabilitation program because they have moderate to severe lung disease.

Doris Skaggs, the first patient in the new cardiopulmonary rehabilitation program at Texas County Memorial Hospital, exercises on the treadmill under the supervision of Matt Eskew, respiratory therapist.

Doris Skaggs, the first patient in the new cardiopulmonary rehabilitation program at Texas County Memorial Hospital, exercises on the treadmill under the supervision of Matt Eskew, respiratory therapist.

Doris Skaggs of Willow Springs was the first patient to take part in the program.  Skaggs was a patient of Mella’s prior to beginning the program.  Skaggs suffers from bronchiectasis and pulmonary fibrosis, a long-term lung inflammation that was worsened by lupus.

“I’ve had lung problems for 35 to 40 years, and before doing this program, I didn’t have the strength to do much of anything,” Skaggs said.

Skaggs began the program in December, and she has already noticed improvement in what she’s able to do on a daily basis.

While recently doing her exercises under Eskew’s supervision in the clinic, Skaggs made arrangements with Eskew to change her appointment time.  Eskew explained that she was planning to host her nephew and his wife at her home.

“I was able to make pies and get their bedroom ready,” Skaggs said, adding, “I couldn’t have done that at all two months ago.”

Eskew noted that Skaggs isn’t the only patient improving through the new program at TCMH.

“So far all of our patients are showing improvements,” Eskew said.

All patients referred to the cardiopulmonary rehabilitation program take part in a six minute walk to identify their individual cardiopulmonary needs.  After completing 36 clinical sessions in the cardiopulmonary rehabilitation program, a patient should be able to walk twice as far, twice as fast.

“Any physician can refer a patient to the program,” Eskew said.  He noted that patients must receive a physician’s referral prior to starting the program.  Patients must also have a pulmonary function test within the past year showing that they qualify for cardiopulmonary rehabilitation.

Once a patient is referred and qualifies for the program, each patient goes through a three-hour initial evaluation.  Eskew explains to each patient his and Mella’s expectations of patients participating in the program.  These expectations include showing up three times a week for rehabilitation and participating in classes outside of the rehab sessions.

“We go through the disease process with patients from A to Z.  We go over medications, and we incorporate a quality of life survey,” Eskew said.  “All of our patients have an individualized counseling and treatment plan.”

Smoking cessation classes and free nicotine replacement are included in the program.  Dietary counseling, group counseling with other lung disorder patients, end of life and advanced directives, are all covered in the program.  Mella also meets with the program patients weekly.

Beverly Keller of Summersville was diagnosed with chronic obstructive pulmonary disorder (COPD) in 1994, and 10 years ago, she had part of a lung removed.

“The only thing my doctor thought would help me is a program like this one,” Keller said.

Keller’s pulmonologist was located in Rolla, and Keller’s pulmonologist encouraged her to participate in a rehab program.  Due to living in Summersville, Keller needed a program that was closer to home for the thrice weekly rehab sessions.

“I called here and asked if there was a lung therapy program, and they took my name and number telling me that they were planning to start one,” Keller said.

Keller also began cardiopulmonary rehabilitation when the program began in November, and she had noticed some differences in her health, too.

“I have learned how to breathe better,” Keller said referring to the breathing techniques that are taught as part of the program, and she added, “The exercise in the program has also really helped my movement.”

At each treatment session Eskew does a clinical assessment of each patient.  If any health problems seem to be occurring with the patient, the patient can be seen quickly by a physician for diagnosis and treatment.

“Another goal of this program is to limit hospitalizations of patients with lung disorders,” Eskew said.

Medicare covers the cost of the cardiopulmonary rehabilitation program for qualifying patients.  Medicare recipients can qualify for a second round of cardiopulmonary rehabilitation.  The TCMH Medivan is also available for patients with transportation needs.

“This program is making a difference in the lives of the patients we are treating,” Eskew said.  “Our patients are regaining their autonomy, assimilating back into regular activities and enjoying an improvement in their lives.”

For additional information about the Cardiopulmonary Rehabilitation Clinic and the cardiac and pulmonary services offered at TCMH, contact the clinic at (417) 967-4182.

Colleen Lebel is Employee of the Month

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Texas County Memorial Hospital has named Colleen Lebel of Salem the January employee of the month.

Lebel is a technologist is the radiology department at TCMH, and she has worked in the department over 10 years.  Lebel was nominated for the award by her supervisor, Ann Hamilton, radiology department director.

“Colleen is the go to person for MRI (magnetic resonance imaging) at TCMH,” Hamilton said, explaining that Lebel worked on the mobile MRI unit at TCMH prior to adding an in-house MRI.

“Colleen has trained other departmental staff in MRI, and she readily shares her knowledge and expertise with our staff,” Hamilton said.

Hamilton described Lebel as “dedicated”, adjusting to work schedule changes with a positive attitude and flexibility.

“Colleen consistently provides excellent customer care and service for all patients that she encounters,” Hamilton said.

As employee of the month, Lebel received a certificate honoring her achievement; a pin; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist; Blissful Nirvana Massage, Wher Motors, and Savor Grill.  A reception will be held at the hospital in honor of Lebel.

Lebel is eligible for the 2017 TCMH employee of the year award.

Colleen Lebel (right), Texas County Memorial Hospital January employee of the month, with her supervisor, Ann Hamilton.

Colleen Lebel (right), Texas County Memorial Hospital January employee of the month, with her supervisor, Ann Hamilton.

Grief Recovery Program to Begin

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Registration is now being accepted for the “Grief Recovery Method: Grief Support Group” sponsored by Texas County Memorial Hospital Hospice of Care.

The seven-week Grief Recovery Method program will begin Monday, March 6th from 5:30 to 7:30 p.m. at TCMH.  Sara McDaniel, a certified grief recovery specialist and social worker with TCMH Hospice of Care, will facilitate the program.  The class is held in the Timmons Education Room at TCMH.

“In coping with grief many people are told to ‘let go and move on in life’, but they don’t know how to accomplish that,” McDaniel said.  “The Grief Recovery Method provides the partnerships and guidance that individuals need to be able to move on with life after a loss.”

The program will provide an action plan for moving beyond death, divorce and other losses such as job loss or health loss.

There is no charge for the program, and the group is open to anyone that is seeking support following a loss.

For additional information or to register for the program, contact McDaniel at TCMH Hospice of Care at 417-967-1279 or


Workplace Violence Reduction Training One of Several New Projects

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Texas County Memorial Hospital has begun a workplace violence reduction program hospital board members heard at their monthly meeting on Tuesday.

“Eighty percent of healthcare-related workplace violence incidents were related to patients, and we have seen a rise in violence here in our own hospital,” Wes Murray, TCMH chief executive officer said.

Murray presented information about Safe Training and Responsible Restraints (STARR), the workplace violence reduction program that TCMH is implementing.

“In a 12 month survey period by the American Nurses Association, 21 percent of registered nurses and nursing students reported being physically assaulted, and over 50 percent were verbally abused,” Murray said.  He added, “Most people wouldn’t take a job with those kind of statistics.”

Centers for Medicare and Medicaid Services (CMS) has created regulations for healthcare facilities to achieve a higher level of safety for patients, visitors, physicians and staff.  TCMH plans to comply with the new regulations.

The Missouri Hospital Association (MHA) chose TCMH to participate in the STARR program along with other hospitals in the state.  Mitigation Dynamics in Lee’s Summit, MO is working with the MHA to train hospital employees and to help participating hospitals put policies and procedures in place in their hospital.

According to Murray, TCMH has submitted the hospital’s current policies for safety and workplace violence.  TCMH employees have also participated in initial training off site.

In March and in April Mitigation Dynamics will have staff at the hospital to do two days of training with 50 TCMH employees.

“We will have staff from a variety of hospital departments—clinics, business office, registration and all of the nursing departments—participate in the onsite training,” Murray said.  Those employees will take their training back to their departments to teach others.

“Everyone with direct patient care needs this training,” Omanez Fockler, TCMH board member and former nurse said, adding, “This is important.”

Murray explained that not only is TCMH looking at the safety aspect but the financial aspect of losing employees that could be injured on the job or forced to leave a job they had trained for if they didn’t handle the violence appropriately.

Board members heard that TCMH has submitted baseline data to MHA for new two-year Hospital Improvement and Innovation Network (HIIN) projects sponsored by CMS.

“The baseline data covered a broad scope—hospital acquired infections, pressure ulcers, workplace injury, and antibiotic use were just a few of the things we reported on at the first of the year,” Amanda Turpin, quality management director at TCMH, said.

Turpin noted that TCMH medical staff members, Dr. Matthew Brown and Sheena Painter, FNP, have been very active in helping set up checklists and protocols for the antibiotic stewardship program that TCMH is creating as part of the HIIN project.

CMS is requiring that healthcare facilities put an antibiotic stewardship program in place.

“There is a lot of data to report, and we don’t have the data mining tools that larger facilities have,” Turpin said, explaining that TCMH staff data mine “with our eyes”.

Turpin also reported that TCMH was one of a few hospitals in the state that completed the baseline reporting by the January deadline.

Murray reported that Wright County 911 will begin dispatching ambulances from their new office on March 9th.

TCMH and Mercy operate ambulances in Wright County with ambulance bases in Mountain Grove, and TCMH is planning to have Wright County 911 dispatch the TCMH Mountain Grove ambulance when needed.  Mercy does not allow their ambulances to be dispatched by the 911 offices.

“When the 911 office dispatches an ambulance rather than first contacting the hospital and having us dispatch the ambulance, five minutes of time can be saved,” Murray said, adding, “And as you know, those potential five minutes are crucial in an emergency.”

Murray also reported that the TCMH emergency department has been working Saint Luke’s Hospital in Chesterfield, MO to transfer some patients for specialty care that is not available at TCMH.

“We have had some issues recently in trying to sending patients to Springfield hospitals because those hospitals have been on diversion due to not having the staff available for all beds,” Murray said.

Murray recounted a weekend in the hospital emergency department with two stroke patients at one time, eight patients with chest pains, and a motor vehicle accident in addition to the usual less acute visits.

“When our emergency department is that busy, our staff needs to spend time taking care of our patients’ needs not waiting on the phone for a hospital to decide if they will take one of our patients,” Murray said.

TCMH has certain criteria to meet in handling stroke and heart attack patients, too, and without quick turnaround times for patients that need a higher level of care, TCMH could lose their state designation for handling stroke or heart attack.

“Saint Luke’s is about the same distance as Columbia, and we already work together on a variety things in our healthcare network,” Murray said.  “The staff at Saint Luke’s has been very receptive to quickly taking our patients when the need arises.”

Murray noted that Saint Luke’s Hospital is a Level II Stoke Center, and the hospital is “equipped and eager” to take patients from TCMH.  The patient services department at Saint Luke’s has prepared packets of information about the area for family members to utilize, too.

“With the flu season upon us and the smaller Cox and Mercy hospitals feeding the larger Cox and Mercy hospitals in Springfield, it has created a tough situation for our patients that need specialized care only available at larger hospitals,” Murray said.

Murray reported that three Medicaid managed care companies have been contacting TCMH about signing non-binding agreements to use the companies for Medicaid patients seeking care through TCMH facilities.

In a plan that has been in place in other parts of Missouri, the state government has turned over Medicaid services to private insurance companies for “Medicaid managed care”.  For a portion of the Medicaid payment, these companies will handle Medicaid services for all Medicaid patients.

Linda Pamperien, TCMH chief financial officer, cited a TCMH case where a Medicaid managed care company refused to pay for a patient delivering a baby, citing the delivery as “not medically necessary” although the patient was receiving managed Medicaid coverage for prenatal care.

“In the past Medicaid has worked like clockwork, but now it’s a mess,” Pamperien said.

Pamperien explained that the managed Medicaid companies want open claims closed within 90 days, and, “It’s not always possible to have a ‘clean claim’ within 90 days,” Pamperien said.  Medicaid claims are closed within a year under the previous plan administration.

In the past, TCMH was able to provide the lowest cost prescription drugs to Medicaid patients, but new state regulations require that prescription drugs for Medicaid patients now come from companies that the state is contracting with.

“Many times, these drugs actually cost us more through those companies, and the state is getting funds back from these companies that they require us to use,” Pamperien said, adding, “It hurts us even more in caring for Medicaid patients when we can’t provide drugs from the pharmaceutical companies that give us bigger volume discounts.”

Murray expressed hopes that changes to the Affordable Care Act would open better interaction with federal and state politicians.

“There is a big push to make changes on a state level, and our federal legislators have committed that they will replace provisions in the ACA before doing away with the law,” Murray said.

Unaudited financial numbers show the hospital ending the year with a negative bottom line of $1,206,966.92 after the month of December ended in the red at -$85,931.51.

“Our representative from BKD has already commented on ‘how much better’ we are this year than last year,” Pamperien said.  BKD, LLC of Springfield provides specialized financial services and an annual audit for TCMH.

TCMH had $2,149,867 in depreciation expense in 2016, slightly less than $2,216,124 in depreciation expense in 2015.  The overall bottom line was 36 percent better in 2016 than 2015, bringing in $730,000 more after expenses than the previous year.

“Our overall revenues were up six and half percent or four million dollars, and our outpatient revenues were up 10 percent or $4.6 million,” Pamperien said.

Inpatient volume was down four percent and swing bed volume was down 27 percent in 2016.

“At the end of the year we are fully staffed with the exception of an additional surgeon,” Pamperien said.  She noted that 2016 hospital budget planning included the addition of Dr. Cory Offutt, a family medicine physician that joined the hospital in July.

“We did not expect to add Dr. Groner and Dr. Mella to our staff this year, but they have also been an added bonus that will benefit our overall revenues in 2017,” Pamperien said.

Dr. Jennifer Groner, a family medicine physician, was recruited in August, and she joined the hospital and the TCMH Mountain Grove Clinic in November.  Dr. Juan Mella, a pulmonologist and sleep studies specialist, joined the hospital part-time in June.

Present at the meeting were Murray; Turpin; Pamperien; Doretta Todd-Willis, chief nursing officer, Joleen Senter Durham, director of public relations, and board members, Fockler; Janet Wiseman, and Dr. Jim Perry, DO.

Board members, Mark Hampton and Russell Gaither, were not present at the meeting.

The next meeting of the TCMH board of trustees is Tue., Feb. 28th at 12 p.m. in the hospital board room.

Dr. Jennifer Groner Is a Mom and a Doctor, Too

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Jennifer Groner, DO

Jennifer Groner, DO

Family.  Relationships.  Dr. Jennifer Groner will tell you that those things are very important to her.

Groner’s early memories involve family–spending time with her dad caring for cattle on her grandparent’s farm in Westphalia.

“I was the youngest of four girls, so even though I was a girl, my dad decided he was going to do everything with me that he would have done with a son,” Groner said with smile.

Cattle farming, fishing, outdoor activities in the Ozarks, were all part of Groner’s childhood.  She grew up in Jefferson City, and her extended family still lives in the area today.

In high school, Groner was a “candy striper”, volunteering at her community hospital, so a career in medicine was something that she considered upon graduating from high school.  But Groner’s path to “doctor” was more adventurous than the usual undergraduate degree to medical school to residency.

Groner went to Notre Dame University in South Bend, IN planning to pursue a career in medicine, but she was disenchanted with the people she met also pursuing the same degrees.  She ended up with a degree in fine arts.

Groner’s education led her to jobs in Chicago and other parts of the US where she experienced working for small businesses and managing projects and people on her own gaining a “perspective on the business world” that is a benefit in her job today as a doctor.

She circled back around to the University of Missouri in Columbia to take required classes for medical school a few years later, and attended medical school at AT Still University in Kirksville, MO.

Groner thought she wanted to be a “family doctor”, taking care of people of all ages and delivering babies.

“A doctor in my program said, ‘You have to go to Appalachia to do that’, discouraging me from that field at first,” Groner said.

Groner considered post medical school residencies in obstetrics/gynecology and general surgery.  She matched with a surgery residency and spent an internship year at Ingham Regional Medical Center in Lansing, MI.

“General surgery was not for me,” Groner said.  “I knew I wanted to have a connection with my patient that went beyond performing a surgery.”

Groner’s thoughts went back to family medicine, and she had the opportunity to join the family medicine residency program at Capital Region Medical Center in Jefferson City.  Groner was able to be close to home at a time when her family needed her while her mom battled cancer.

“While I was in Jefferson City, I found a program in Kansas City where I could do some extra training and be the family medicine doctor that delivered babies that I always wanted to be,” Groner said.

After completing residency, Groner went to the University of Missouri at Kansas City School of Medicine for fellowship training in surgical obstetrics.

A one year program actually turned into seven years in Kansas City because Groner was offered a “dream job” as attending physician in the department of community and family medicine and assistant professor at the UMKC family medicine and obstetrics program.

“In Kansas City, I was doing what I wanted to do,” Groner said, describing the position as “mini obstetrician”.

“I loved working with the residents in the program,” Groner said. “Watching the residents grow was gratifying, and the people I worked with were fun.”

In Kansas City, Groner delivered and oversaw the delivery of hundreds of babies.  She had the opportunity to provide care for women and families of many different cultures and backgrounds.  Groner also grew her own little family—Matthew was born in 2012 and Sarah was born in 2015.

“I always knew that at some point in time, I wanted to practice traditional family medicine,” Groner said.

In 2016 Groner began looking for a new opportunity, and UMKC resident, Cory Offutt, MD told her about the position he was taking at Texas County Memorial Hospital.

“I love the rural setting, and folks around here are familiar to me,” Groner said about her visit to TCMH.

Groner wanted a safe place and a small town to raise her children.  She sought a place not too far from her extended family in Jefferson City.  Taking the job with TCMH “felt right” to her.

When Groner was initially recruited to TCMH, it was not to work full-time at the Mountain Grove Clinic because TCMH had difficulty recruiting physicians doing obstetrics to work full-time at a clinic 25 miles from the hospital.  Groner visited the clinic and the community and requested to work full-time in Mountain Grove.

“I want to build relationships with the people here,” Groner said.  She recognized the opportunity to be the physician leader of a clinic in a small town.

Groner signed a three-year contract with TCMH in August, and began practicing at the Mountain Grove clinic in mid-November after buying a home and moving with her kids to the area.

Groner envisions growing the clinic practice while working alongside Sara Openshaw, the established family nurse practitioner at the TCMH Mountain Grove Clinic, providing the full gamut of care for all age ranges and delivering babies and providing hospital inpatient care at TCMH.

“The best part of family medicine is being able to provide that ongoing care,” Groner said.  “You start with one aspect of the patient’s care, and you continue taking care of that patient for many years.”

So, Groner’s second dream job began in Mountain Grove.

In Mountain Grove, Groner wants to take care of mom while she’s pregnant, deliver the mom’s baby and continue to provide care for mom and the baby after delivery.  Groner wants to provide school physicals and immunizations for those children as they grow.  She wants the clinic door to be open to walk in patients as well as patients that need regularly scheduled medical care for chronic conditions.  Groner wants mom and dad, the kids, and grandma and grandpa to find a medical home with her.

“I love the variety in rural family medicine,” Groner said, noting that sometimes the care is very routine and sometimes the care is very unusual.

Again, Groner circles back around to the importance of family.

As a woman and as a single mom Groner understands the demands placed on women in the workplace calling them a “challenge”.

“We all go to work to support our families, and there’s the push and pull of family while we are trying to make a living,” Groner said.

“So many women I talk to are making decisions for their family daily because their spouse has a job on an oil rig or with the railroad,” Groner said, adding, “I know that feeling.”

Groner hopes that the area moms and all the patients that utilize the TCMH Mountain Grove Clinic will find a “home” with her and the clinic staff.

“I am looking for a ‘family-feel’ in our clinic,” Groner said.  “I hope everyone here enjoys their job and the people they work with, so we are able to share that good feeling with our patients.”

Groner is accepting new patients at the TCMH Mountain Grove Clinic.  Walk in patients are welcome, although appointments are preferred.  The clinic is open Monday through Friday from 7:40 a.m. to 5 p.m.

Additional information about the clinic or an appointment is available by calling (417) 926-1770.


Contest Benefits TCMH Hospice of Care

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Texas County Memorial Hospital Hospice of Care is the beneficiary of $323.78 following this year’s Christmas tree contest hosted by D & L Florist in Houston.

Shari McCallister, owner of D&L Florist, hosts the contest annually by decorating numerous trees in her shop with various themes for Christmas.  Visitors to the store are asked to vote on their favorite tree with money.  One penny counts for one vote, and all of the funds collected go to TCMH Hospice of Care.

“Voting for a tree has become a family tradition for many,” McCallister said, explaining that grandchildren are brought in by their grandparents, mothers and daughters and groups of friends come in together.

The majority of the funds collected are small change, but many people vote with paper money, too.

“There are quite a few one dollar bills, and some large bills, too,” McCallister said.

McCallister noted that the fundraising effort is a giving opportunity for many people that might not be asked to give to a local charity on a regular basis.

“The Hospice of Care team took care of my father, Doyle Sillyman, and it’s an honor to be able to give back to them through this contest each year,” McCallister said.

McCallister said the “red bird and burlap tree” was the winner of the 2016 contest, garnering the most votes.

The funds collected will go into the Hospice of Care Fund managed by the TCMH Healthcare Foundation.  The funds will be utilized locally to help provide end of life care for Hospice of Care patients and their families.

According to Jay Gentry, director of the TCMH Healthcare Foundation, the Christmas tree contest has raised $2,267 for Hospice of Care since the contest began in December 2007.

Shown here with the donation are (left to right), Courtney Owens, Hospice of Care director; Shari McCallister, D&L Florist owner, Sandy Eaton, Hospice nurse, and Jay Gentry, TCMH Healthcare Foundation director.

Shown here with the donation are (left to right), Courtney Owens, Hospice of Care director; Shari McCallister, D&L Florist owner, Sandy Eaton, Hospice nurse, and Jay Gentry, TCMH Healthcare Foundation director.

Kristy Weaver is Employee of the Month

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Texas County Memorial Hospital has named Kristy Weaver of Houston the December employee of the month.

Weaver is a technologist is the radiology department at TCMH, and she has worked in the department over 17 years.  Weaver was nominated for the award by her supervisor, Ann Hamilton, radiology department director.

“Kristy takes pride in her work and strives to complete the highest quality exams for each patient,” Hamilton said.  “She also contributes to creating a positive work atmosphere for everyone within the department.”

Weaver is cross-trained in multiple modalities within the radiology department, so she is able to work in several different areas of the department.  Weaver is known for volunteering to help out if staffing issues arise within the department.

“The customer service that Kristy consistently provides contributes to making the radiology department great,” Hamilton said.

As employee of the month, Weaver received a certificate honoring her achievement; a pin; a special parking place in the TCMH lot; one day of paid vacation; a $50 gift card, and gift certificates to Paws N Claws, D&L Florist; Blissful Nirvana Massage, Wher Motors, and Savor Grill.  A reception will be held at the hospital in honor of Weaver.

Weaver is eligible for the 2017 TCMH employee of the year award.

Kristy Weaver, right, with her supervisor, Ann Hamilton.

Kristy Weaver, right, with her supervisor, Ann Hamilton.

First Baby of the Year Arrives

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Hadley Rebecca

Hadley Rebecca

It’s a girl!

Hadley Rebecca Dillin took the honors as the first baby born at Texas County Memorial Hospital in 2017, arriving at 2:02 a.m. on Monday, January 2nd.

Baby Hadley is the first child of Sarah Dillin of Cabool.  Dr. Cory Offutt, physician at the TCMH Medical Complex in Houston, delivered baby Hadley, and she was six pounds, 14 ounces and 20 inches long.

Roma Hollenbeck and Julia Bryant, representatives of the TCMH Auxiliary,  and Wes Murray, TCMH chief executive officer, presented gifts and gift certificates to Hadley and her mother after her birth.  Businesses throughout the county donated the gifts to celebrate the arrival of the first child born at TCMH in 2017.

Sarah Dillin, seated, holds Hadley Rebecca Dillin, the first baby born at Texas County Memorial Hospital in 2017.  Presenting gifts to the Dillin family were (standing left to right) Roma Hollenbeck, TCMH Auxiliary; Wes Murray, TCMH CEO, and Julia Bryant, TCMH Auxiliary.

Sarah Dillin, seated, holds Hadley Rebecca Dillin, the first baby born at Texas County Memorial Hospital in 2017. Presenting gifts to the Dillin family were (standing left to right) Roma Hollenbeck, TCMH Auxiliary; Wes Murray, TCMH CEO, and Julia Bryant, TCMH Auxiliary.


Data Shows TCMH Patients Receive Healthcare at Much Lower Cost

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Texas County Memorial Hospital ranks below state and national averages in healthcare spending per Medicare beneficiary, hospital board members heard at their monthly meeting on Tuesday.

“Hospital ratings have once again been in the local news, and we compare very well with hospitals large and small,” Wes Murray, TCMH chief executive officer said, adding, “But the 2015 data for Medicare spending per beneficiary shows just how well we are spending the funds given to us for a patient’s healthcare in comparison to other hospitals.”

Amanda Turpin, quality management director at TCMH, presented the Medicare spending data from the Center for Medicare Services (CMS) 2015 calendar year compiled into a Missouri Hospital Association (MHA) report.

“This data is available publicly, and the MHA compiled it so Missouri hospitals could see areas where they could improve the cost of the care they provide,” Turpin said, explaining that CMS reimbursement is tied to the cost and efficiency of the care provided to Medicare patients.

The MHA data provides information showing the cost of healthcare for Medicare patients before admission to the hospital, during a hospital admission, and up to 30 days after admission.

Average spending one to three days prior to admission to TCMH is $508. It’s $774 on a state level and $707 on a national level.

Average spending during a hospital inpatient stay at TCMH is $6,222. The state average is $10,973, and it’s an average of $10,888 nationally.

One to 30 days after discharge, the average spent on a TCMH Medicare patient is $5,653. The state average is $8,305, and the national average is $8,902.

“We already know that our readmission rate is higher than the CMS goal for our hospital,” Turpin said, “But what’s really important here is that our spending on our patients is actually much lower than state and national averages.”

Turpin noted that many times Medicare patients at TCMH are facing multiple chronic conditions.

“We take care of a lot of patients that are at the end of their life, and they are so ill, they will be back in the hospital soon,” Turpin said.

Murray explained that the data is not risk-adjusted, so it doesn’t account for the higher acuity level of patients in rural Missouri.

“We are typically taking care of sicker patients, and we’re doing it much more efficiently than our hospital counterparts in Missouri and across the US,” Murray said.

Murray plans to share the data with federal legislators and specifically with 8th District Congressional Representative Jason Smith who is visiting the area later this week.

“We have been asked to provide input regarding reshaping the new healthcare plan, and it’s important that Representative Smith is aware of this information in his district,” Murray said.

“We are doing everything we can to manage our costs, but rural hospitals are at a disadvantage,” Murray said.

Murray explained that TCMH writes off 15 percent of gross revenue annually, while the average hospital in the US writes off only five percent of gross revenue annually.

“Some of our write offs could have been addressed by statewide Medicaid expansion,” Murray said, adding, “The majority of our payors are Medicare and Medicaid, and there’s still a gap in the payment for the coverage those patients receive at TCMH.”

Murray explained that currently the federal government puts a large focus on hospital readmissions without adjusting the data based on overall population health or location and the age of the patient.

“I would like to see the federal government focus on what’s really being spent to care for patients without penalizing us for taking care of more elderly patients,” Murray said.

Board members agreed that the data needed to be shared with federal and state legislators.

“Now is the time to really talk about all of this, while they are planning to make changes,” Omanez Fockler, TCMH board member, said.

On December 6th, TCMH staff met with two cardiologists, a clinical nurse, and a state surveyor to complete the hospital’s review for Department of Health and Senior Services (DHSS) certification as a “Level IV STEMI” hospital for their ability to respond to patients experiencing a ST segment elevation myocardial infarction or STEMI, commonly referred to as a heart attack.

“Our exit interview concluded with zero deficiencies identified, and the review team will submit a letter to the state asking them to give us Level IV STEMI designation,” Doretta Todd-Willis, TCMH chief nursing officer said.

TCMH was one of 58 hospitals in Missouri seeking STEMI designation in the first round of requests. The team reviewing the sites hopes to complete the first round of requests in 2017 and hand out official designations.

TCMH anticipates that the state will begin requiring emergency services personnel to take patients with heart attack-like symptoms to the closest STEMI designated hospital in late 2017.

“We are pleased to be in the first round of reviews for state STEMI designation, and our team has been working on receiving this designation since 2015,” Todd-Willis said.

Murray noted that an official from the state described the TCMH review as one that “set the bar for Level IV STEMI certification”.

“I can’t say enough about our team and the job they did to prepare for the site review,” Murray said.

TCMH received designation as a Level III Stroke Center from DHSS in March 2015. The Level IV STEMI designation is the second state designation sought by the hospital in the past few years.

Also at the December meeting, approval was given by the board members for the hospital’s 2017 capital and operating budgets.

Linda Pamperien, TCMH chief financial officer, presented the budget data for the upcoming year.

The $957,203 capital budget is a 32.3 percent increase from the 2016 capital budget. Since 2013, the capital budget has been in the $700,000 to $758,000 range, and this year’s capital budget has several large ticket items.

CMS has mandated wireless computed radiography in 2017, and TCMH will spend $158,000 for the hardware and software to fulfill that requirement. An additional $166,000 is budgeted for computer hardware and software upgrades in various departments in the hospital, upgrading electronic medical records in the clinic, and upgrading the hospital’s system-wide computer system.

Other larger items in the 2016 capital budget are a new ambulance for $120,500; a new chiller for the surgery/obstetrics/intensive care wing of the hospital for $80,000; one new intensive care unit bed totaling $25,000, and a new gastroscope for $36,480.

TCMH is using a variety of funding sources to complete the interior of the planned surgery department, and $110,000 is included in the 2016 capital budget to go toward the infill.

Board members also approved the 2016 operating budget of $31,666,160 that projects excess revenue over expenses of $170,427.

“We have had additional, unanticipated expenses with the addition of new physicians this year,” Pamperien said, referring to the addition of Juan Mella, MD and Jennifer Groner, DO to the TCMH Medical Staff.

“There are always some additional costs when a new physician is getting started, but we’re going into 2017 knowing that we have these new physicians contributing to our bottom line,” Pamperien said.

The 2017 operating budget anticipates a 7.1 percent increase in inpatient revenue, a 10.7 percent increase in outpatient revenue, an 8.3 percent increase in emergency department revenue and a five percent increase in swing bed revenue.
Pamperien explained that a hospital employed primary care physician usually generates about $4.5 million in gross revenue annually for the hospital through hospital inpatient and outpatient services.

“In 2016 we met and exceeded our budgeted outpatient and emergency department revenues, but our inpatient revenue numbers were lower than anticipated,” Pamperien explained.

Pamperien does not anticipate the “contractual adjustment”—the difference between the hospital charge and the portion of the charge covered by insurance—to change greatly in 2017. The contractual adjustment for 2017 is anticipated to be 61.9 in the operating budget.

Two full-time positions are budgeted additions to two departments in 2017. The budget also includes operating the Sleep Studies Laboratory seven days a week, up from five days a week; continuing operations of the chronic condition home care program, and operating the pulmonary rehabilitation clinic all year long.

“Again, we are budgeting to ‘break even’ in 2017,” Pamperien said, adding “But we are more fortunate than many other facilities. Our accounts receivable and cash flow are very good.”
In the monthly financial report Pamperien reported a negative bottom line in November of $188,289.98 for a negative year-to-date balance of $1,221,035.41.

Present at the meeting were Murray; Turpin; Todd-Willis; Pamperien; Joleen Senter Durham, director of public relations; Dr. Jonathan Beers, chief of staff, and board members, Fockler; Janet Wiseman, and Mark Hampton.

Board members, Dr. Jim Perry, DO and Russell Gaither were not present at the meeting.

The next meeting of the TCMH board of trustees is Tue., Jan. 24th at 12 p.m. in the hospital board room.

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