Texas County Memorial Hospital has experienced steady growth for swing bed patients in the past five years TCMH board members heard at their monthly meeting on Tuesday.
“With new, expanded information available from the Hospital Industry Data Institute (HIDI) we are able to compare our swing bed days and discharges with other hospitals across the state,” Wes Murray, TCMH chief executive officer, explained. “Since 2008, our number of swing bed discharges has grown every year.”
A swing bed admission is for a patient that has had at least three days of hospitalization in an acute care setting for a condition such as stroke or surgery. Patients are admitted to a hospital swing bed where they can receive round the clock care while continuing to recover.
Swing bed patients have access to a social worker and case manager, many types of therapy, weekly physician visits, a dietician and other services available through the healthcare facility.
According to Murray, many patients and their family members choose to be transferred to TCMH for swing bed care after a hospitalization at a larger healthcare facility. Some patients also are changed over to swing bed status while at TCMH for a surgery or other illness if the patient requires additional care.
In 2008 TCMH had 28 swing bed discharges compared to an average of 78 discharges at other hospitals in the state. In 2013 TCMH had 175 swing bed discharges compared to an average of 91 discharges at other hospitals in the state.
“Our physicians are really embracing the swing bed process,” Murray said.
Murray described swing bed care as “less intensive”, but important in a hospital where the average patient age is over 70.
“Hospitals everywhere are managing their average length of stay for patients more aggressively, so the need for swing bed care is rising,” Murray said.
The HIDI data also shows that TCMH swing bed patients average shorter long term stays than swing bed patients at other hospitals in the state. In 2013 the average length of stay for a TCMH swing bed patient was 3.63 days and the statewide average was 5.49 days.
“Swing beds are very beneficial for our patients and for the families of the patients,” Murray explained.
Murray credits the uptick in swing bed usage to Dr. Jeffrey Kerr, emergency department medical director at TCMH. Kerr also works as medical director at several area nursing homes, and he has a strong background in geriatric issues.
“Dr. Kerr began encouraging our medical staff in utilizing swing beds with their hospitalized patients, and he educated our physicians about the importance of accepting new swing bed patients that were transferred from other hospitals,” Murray said.
Kerr and his staff in the TCMH emergency department also provide education to patients and their family members about the option of returning to TCMH for swing bed care when needed.
“As our physicians’ knowledge of the service has grown, so have the number of patients we are caring for through swing bed at TCMH,” Murray said.
According to Murray, swing bed care is covered by most private insurance, including Medicare. Private insurers may require prior authorization for swing bed care and vary in coverage options.
In order to qualify for Medicare reimbursement of a swing bed stay, the patient must have spent at least three days within the last 30 days in an acute setting. Medicare will cover 100 percent of a patient’s stay for the first 20 days, as long as the patient is receiving skilled services of some type. These skilled services incude IV medication, diabetes management, physical or speech therapy, respiratory therapy, frequent medication changes, lab monitoring or surgery that includes dressing changes or other post-op care.
On the twenty-first day of a patient’s swing bed stay, Medicare will continue to pay 80 percent of the cost and the patient is responsible for the remaining 20 percent of the cost if there is no co-insurance. Medicare replacement may cover the co-insurance portion and require prior authorization.
Murray also reported to board members that recruiting efforts at the hospital have been strong over the past few weeks. Four candidates with obstetrical training have been brought to the hospital to interview for a position at the TCMH Medical Complex in Houston.
“I have several additional obstetrics providers identified, and one is scheduled to visit on Friday,” Joleen Senter Durham, director of physician recruiting at TCMH, said. “We are hopeful that one of these candidates will be the right fit for us as well as find their own right fit here at TCMH and in our community.”
Durham reported that she also has a site visit scheduled for a family medicine provider for the TCMH Mountain Grove Clinic and for a mid-level provider that grew up in the area. She continues to recruit for a general surgeon, too.
Leroy Wombold, MD, a general surgeon from Phelps County Regional Medical Center in Rolla, will provide general surgery coverage and do a general surgery clinic at TCMH one and a half days a week beginning in April. Lowell Fisher, DO, also a general surgeon from Rolla, has been providing surgical coverage at TCMH since late 2013, and he will continue to provide coverage at the facility. Charles Mueller, MD, current general surgeon at TCMH, has extended his time at the hospital through the end of April.
“A lot of time and effort has gone into contacting physicians to provide for our coverage needs as well as our long-term recruiting needs,” Murray said. “Although it is not a quick process, Joleen has made some strong contacts through her recruiting efforts, and one or more of those individuals may work out as full-time employees of TCMH.”
Also at the meeting, Murray reminded the hospital board members that the Wright/Texas County 9-1-1 office located on the TCMH campus does not pay rent or utilities to the hospital for the space they have used since the service’s inception.
“There is a tax measure on the upcoming election ballot that would help fund Wright/Texas County 9-1-1 through a county sales tax,” Murray said, noting that the loss of the service “would place an additional burden on the hospital”.
Murray explained that TCMH has been involved in the Wright/Texas County 9-1-1 board meetings because the majority of calls into the service require an ambulance to be dispatched.
“They have their own board and operate independently of the hospital,” Murray said, explaining that some “miscommunication” has indicated that TCMH would take over Wright/Texas County 9-1-1.
“We do not have a plan to take over Wright/Texas County 9-1-1, and if the service is no longer available, we will go back to dispatching our own ambulances,” Murray said.
During the summer, TCMH will provide some space to the Cox College of Nursing/Drury University nursing fundamentals cohort. The cohort is enrolled in the Cox/Drury Cabool campus, but the space is not available for the cohort to use at this time.
“We will make available a few rooms on the East wing for the cohort to use until their new space is ready,” Murray said, explaining that the students and the school are “very excited” about the opportunity to use actual hospital space.
“The school will place one of their simulator mannequins in one of the rooms, and the students will be exposed to a real hospital environment and real hospital rooms,” Murray said.
Dr. Jim Perry, OD, TCMH board member and Cabool resident, complimented the efforts of Drury and Cox working together to bring additional nursing education to the area.
“Nursing training available through Drury in Cabool is such a good thing for area students because the students that complete the program can make a living anywhere,” Perry said.
The February financial report reflected a drop in inpatient and outpatient revenues for a $32,221.43 loss, but the year-to-date balance is positive at $8,436.70.
“Last year we took a major hit with the February financials, and this month is much better than 2013,” Linda Pamperien, chief financial officer at TCMH said.
Pamperien reported that the February financials show interest accrual on the recent capital project for both January and February. Because the expansion project is not complete, loan payments have not yet begun. Pamperien also pointed out that TCMH has three payments left on a bond note for capital improvements done in 2000. That note will be retired in July.
“The field portion of the 2013 annual audit has been completed,” Pamperien said. “BKD will present the audit at next month’s meeting.”
BKD, LLC from Springfield does the annual audit which includes an onsite review portion that is done each year in March.
Present at the meeting were Murray; Pamperien; Durham; DorettaTodd-Willis, chief nursing officer; Dr. John Duff, and board members Perry; Janet Wiseman; Mark Hampton, and Russell Gaither.
Board member, Omanez Fockler, was not present at the meeting.
The next meeting of the TCMH board of trustees is Tue., April 22 at 12 p.m. in the hospital board room.