Workplace Violence Reduction Training One of Several New Projects

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 9^th.

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.