Efforts are underway at Texas County Memorial Hospital to improve the process of referring patients to specialists in other healthcare systems, board members heard at their monthly meeting on Tuesday.
Wes Murray, TCMH chief executive officer, noted the two biggest issues are a lack of beds at referring hospitals and seamless referral of patients to specialists when needed. The referral issues stem primarily from patients being referred from the emergency department at TCMH.
“We are at the mercy of the physicians we’re referring our patients to,” Murray said.
Springfield is the primary referral route for most patients requiring a transfer or specialist care, and hospital physicians and staff will try to work with the patient’s hospital preference whenever possible.
“In the case of psychiatric patients, we may have a patient waiting 24 hours at our hospital while we try to find a bed for the patient anywhere in the state,” Murray explained.
A patient referred from the TCMH emergency department may also have to wait to follow up with a specialist.
“Our ER physician may make contact with the specialist on call at the referring hospital, and the specialist will tell our staff to have the patient come to his or her office the following day,” Murray said. He described issues with patients from TCMH showing up to be seen by the specialist only to be turned away at the office because the information from the referring physician and hospital was never passed on to the specialist’s office.
“Our privacy laws have also superseded the benefits of hospital electronic medical records,” Murray said.
Murray recounted frustration experienced by patients that have a radiologic procedure at TCMH that a physician from another medical facility refuses to view because it requires opening a disc from TCMH. Although the patient’s data is stored electronically, there is not an easy way for the patient’s data to be accessed from one hospital to another, computer to computer.
“As these issues have grown more common, we are seeking ways to help our patients get the specialized care they need,” Murray said.
Information systems personnel at TCMH and CoxHealth have worked together to create a portal between the TCMH and CoxHealth systems that would give a specialist access to electronic medical records for one specific patient referred to them. Murray noted that the portal requires someone from CoxHealth to manually download the information, and CoxHealth has staff available 24/7 to download the information when needed.
“We greatly appreciate CoxHealth working with us to set up this portal system,” Murray said.
Murray explained that the single use patient portal will be “extremely beneficial” to patients that need care after traditional business hours and to critical care patients that require trauma or stroke care.
“We have made progress in correcting a frustrating situation for our physicians, our patients, and the family members of TCMH patients,” Murray said.
Murray noted that frustrations had increased with the growing volume and higher acuity of patients in the emergency department.
Dr. Jonathan Beers, TCMH chief of staff, agreed that a portal providing patient information access to specialists at other hospitals would be helpful in many different cases.
Beers also cited instances of specialists at outside facilities agreeing to take a TCMH patient, only to find that the physician goes on vacation or doesn’t speak with his or her office about the patient.
Earlier in the year, TCMH began working with working Saint Luke’s Hospital in Chesterfield, MO to transfer some patients for specialty care that is not available at TCMH. Officials at Saint Luke’s welcomed transfers for specialized care, and beds were readily available at the hospital, too.
Beers said that he has not had any issues working with specialists at Saint Luke’s.
“They are ready and eager to take our patients when we can’t find a bed or a specialist that will treat our patients,” Murray said about Saint Luke’s Hospital.
Murray noted that Chesterfield—located in St. Louis County—is not too far off I-44, and about five minutes closer by car than Columbia.
Beers explained that occasionally his patients don’t want to get specialized care through Saint Luke’s due to the distance from TCMH, but those patients that have used Saint Luke’s have had good experiences.
“We are working to train all of our ER staff and physicians that Saint Luke’s is another resource for patients when a hospital bed or a specialist isn’t easily accessible in Southwest Missouri,” Murray said.
Murray shared a letter from the Missouri Department of Health and Senior Services approving the engineering plans for the new surgery department infill. The plans were submitted a couple of years ago, but needed to be re-submitted since the construction had not begun shortly after the original approval.
“Our maintenance department has already started working on the surgery department project,” Murray said.
Completion of the surgery department interior is expected to take 12 to 18 months. The plans include two new operating rooms and an endoscopy suite as well as private recovery rooms.
Joleen Senter Durham, director of physician recruiting at TCMH, told board members that the recruiting of Dr. Doug Crase for the TCMH Family Clinic in Licking fills all of the current primary care needs at TCMH.
Crase is a family medicine and obstetrics trained physician. He is currently in his final year of residency, and he will start work at TCMH next summer.
Also joining TCMH next summer are Dr. Jason Loden, a general surgeon, and Dr. Teresa Loden, a pediatrician. Teresa Loden is practicing full-time in Omaha while Jason Loden completes his residency.
“We have been incredibly fortunate in the past few years, being able to recruit physicians and mid-level providers without the use of any outside recruiting agencies,” Durham told board members. She explained that on the “minimum” side, recruiting would be $15,000 for a mid-level provider and $22,000 for a physician.
Durham tallied that currently TCMH has 12 healthcare providers currently working at the hospital that were recruited without any outside agency’s assistance.
“With our current physicians and mid-level providers and the physicians planning to join us next summer, we have saved a minimum of $281,000 in outside agency fees to recruiting companies,” Durham said.
Durham complimented the staff at TCMH on “taking advantage of every opportunity” to identify and work to recruit healthcare providers.
“That is a lot of money for our hospital to save over the past few years, and I’m very proud of our efforts,” Durham said.
Due to higher contractual adjustments and decreased inpatient volumes in June, TCMH revenues did not meet budgeted expectations, according to the June financial report from Linda Pamperien, TCMH chief financial officer.
TCMH ended the month of June with a negative bottom line of $171,502.29 and a negative year to date bottom line of $118,884.98.
Present at the meeting were Murray; Beers; Durham; Pamperien; Amanda Turpin, quality management director, and board members Dr. Jim Perry, OD; Jay Loveland; Janet Wiseman, and Omanez Fockler.
Board member, Mark Hampton, was not present at the meeting.
The next meeting of the TCMH board of trustees is Tue., August 22nd at 12 p.m. in the hospital board room.