Physicians and Staff are Working Together to Keep Patient Services Local

                Texas County Memorial Hospital board members learned at their monthly meeting on Tuesday that a concerted effort is underway to keep patients at TCMH and using TCMH healthcare providers and services whenever possible.  

In his administrative report, Wes Murray, chief executive officer at TCMH explained that the physicians, departments and administration at TCMH are working together to keep communication open and to provide education regarding the services available in the hospital and through the TCMH medical staff.

                Murray also presented the first draft of a new strategic plan document which includs the strategic objectives of increasing the hospital’s market share and strengthening the hospital’s financial position.

                “Conversations that began with our department managers going out to educate clinic staff and physicians about our new equipment and discussions that we have had with our physicians about referral patterns are starting to make a difference,” Murray said.

                “Part of our strategic plan in the upcoming year is that everyone will have an understanding of what we do have to offer,” Murray said, explaining that even employees working at TCMH don’t know always know what is available inside the hospital where they work.

                Schuan Flaim, DO, chief of the TCMH medical staff, and one of three internal medicine physicians employed at the TCMH Medical Complex in Houston, explained that he and his fellow internal medicine colleagues—Gretchen Price, DO and Jonathan Beers, DO–are also trying to educate fellow members of the medical staff about the types of patients they can see and manage.

                “As internal medicine physicians, we trained to handle a wide variety of complex medical issues,” Flaim said.  “If the family medicine docs and mid-level providers will refer patients to us rather than sending them to a specialist, we can take care of the patient and their disease.”

                Flaim explained that many times patients that are referred to specialists at larger facilities in Springfield or other towns are not able to see the specialist for several months.  Then, the specialist only treats one specific thing, such as the heart or the kidneys.

                “Jon, Gretchen and I trained to manage multiple complex chronic diseases,” Flaim said.  “We are very capable and willing to see these patients, and if they do have a problem that a specialist needs to handle, we will refer those patients.”

                Omanez Fockler, chairperson of the TCMH board of trustees, explained that she has had personal experience with a family member that benefits from the care of a local internal medicine physician. 

                “Dr. Flaim is able to cover all the issues rather than seeing a different specialist for each issue,” Fockler said.  “The patients don’t have to make multiple trips out of town to see many different doctors.”

                “It’s so much better for our patients when they can have most of all of their care managed by one physician,” Doretta Todd-Willis, chief nursing officer, said.  “The doctor knows the patient as a whole person.”

                Flaim explained that one of the area mid-level providers now refers all of her diabetic patients to him first rather than to an endocrinologist. 

                “Many times, it takes three months for a patient to be seen by a specialist, but we can see the patient within a week or so,” Flaim said, adding that it also saves the patient money and time because they don’t have to make multiple trips out of the area for doctor visits.

                Flaim noted that many family medicine physicians and mid-level providers are taught in their training programs to refer patients to specialists rather than internal medicine physicians.  Residents in the community don’t think to ask to see a local internist rather than a specialist in a town they have to travel to.

                “Our community is starting to get an idea that internal medicine and family medicine physicians are different, but our practices are complementary to each other in a setting like the one we have at TCMH,” Flaim said.

                Fockler thanked Flaim and the hospital on their efforts.  “Providing care for the whole person is what this hospital is all about,” Fockler said.

                Also part of the strategic objectives in the 2014 strategic plan at TCMH is preparation for new payment structures and creating an engaged and developed workforce.

                “There are 12 projects that you can see here that will help us achieve our objectives,” Murray said after providing a rough draft handout.

Those projects include recapturing the Mountain Grove market, developing a telehealth program, and increasing efficiency in the emergency department.  Each project has specific goals and measures to drive those goals.

                “We are still working through this document, but when it’s complete, we will have copies that each department manager will have on their desk to keep all of us focused on our strategic plan,” Murray said.

                Murray reported that TCMH is beginning an employee wellness incentive program in December.  The program will incentivize all hospital employees to get their annual wellness screenings through TCMH providers and services.

                “Our health insurance rates went up 9.3 percent this year,” Murray said.  “Five percent of that increase came from the ‘soft tax’ imposed on all employer provided health insurance plans as part of the Affordable Care Act.”

                Murray explained that TCMH can “help ourselves” by getting more employees to utilize the preventative and wellness screening that are part of the health insurance plan. 

                “Less than 10 percent of our employees utilized the wellness benefits available through our insurance plan in 2013,” Murray said.

                All employees—even TCMH employees that do not have the hospital’s insurance plan—are eligible for the wellness incentive program.

                “We want our employees to be healthy and to prevent life threatening diseases,” Murray said.  “We also want our employees utilizing our providers and our services.”

                Murray called the wellness plan a “win-win” for the employees and the hospital and healthcare providers. 

                In other news,TCMH has filed the attestations needed for Stage 1 Phase 3 with Medicare and Stage 1 Phase 2 Medicaid electronic medical records incentives.  TCMH has already received over $1 million in funds for reaching other levels of EMR incentives set by the federal government.

                According to Linda Pamperien, chief financial officer at TCMH, the EMR incentive funds will be reduced by two percent due to the sequestration that went into place in March 2013.

TCMH expects to receive a total of $811,754.00–$488,164.00 from the Medicare portion and $323,590.00 from the Medicaid portion. The EMR funds will have a direct impact on the 2013 financial statement.

Pamperien explained that with the help of BKD, LLC in Springfield, the hospital’s auditing and accounting firm, TCMH has applied for a hardship request from the federal government so the hospital can collect funds that are owed to the hospital by the federal government from previous years of Medicaid cost reports.

“We are currently owed $2.1 million by the federal government for cost report settlements going back to 2007,” Pamperien said.  “We will get the money eventually, but we don’t know when we will get it.”

Pamperien and BKD hoped to get the back funds that are owed to the hospital to help offset the poor financial year at TCMH.  However, the hardship request may be denied because of the funds TCMH currently has in savings, known as “funded depreciation”.

“If we owed Medicaid, they would take it out from us immediately,” Pamperien said, expressing frustration with the government payment system.

According to Pamperien’s October financial report, most hospital departments showed increased volumes for the month of October, but it was not enough to offset decreased inpatient revenues and a drop in emergency department numbers.

TCMH had a loss of $141,514.82 for the month of October and a year to date loss of $967,743.85.

                Present at the meeting were Murray; Pamperien; Todd-Willis; Flaim; Joleen Senter Durham, director of public relations; Dr. John Duff; and board members, Fockler; Dr. Jim Perry, OD; Janet Wiseman; Mark Hampton and Russell Gaither.

                Due to the Christmas holiday, the next meeting of the TCMH board of trustees has been moved up one week to Tuesday, December 17 at 12 p.m. in the board room of the hospital.