Magnolia Regional Medical Center Excels as a Hospital in Transition
Eric Shell, Director, and Matt Mendez, Consultant, with Stroudwater Associates, worked with Magnolia Regional Medical Center (MRMC) in 2016, through the Small Rural Hospital Transition (SRHT) project, on a Financial Operational Assessment (FOA). RHI staff spoke with Rex Jones, CEO, and Roxanne Stewart, Chief Financial Officer, in May concerning their continued progress on this project.
Q: What are some of your hospital's successes regarding implementation of Eric and Matt’s recommendations?
A: MRMC is making progress on goals regarding primary care recruitment and alignment. The medical staff were involved in the strategic planning sessions. CEO Rex Jones, who joined the hospital in December 2016, has been meeting with individual physicians and discussing hospital standing and the strategy moving forward. They are also discussing the medical staff’s opinions about the most pressing community needs. MRMC is discussing primary provider recruitment with the University of Arkansas for Medical Science (UAMS) and are collaborating to bring in one part-time family practitioner and have the potential for a new full-time family practitioner. They also continue to work with UAMS clinics concerning referrals that might be going elsewhere. Work is underway to recruit an internal medicine provider with a pulmonology specialty.
To impact the culture of quality and patient safety, MRMC recently shared the results with staff from their national patient care safety culture survey. They are creating a dashboard that will include quality issues and report it to the board monthly. The CEO is working with medical staff members to determine who will be the best champion for quality. Issues were identified by this group, have been addressed and through the process, they are determining which physician can carry the “quality torch.” They have seen some improvement in HCAHPS scores and discussed the scores with all employees in town hall meetings with a focus on the need to ensure quality and patient safety to improve care and patient satisfaction.
To better promote outpatient and ancillary services, MRMC identified a “promotion team” to reach out to clinic staff and office managers. They are using billboards, advertisements and social media. Under their new CEO, they are re-evaluating their marketing plan.
Developing a functioning swing bed program had been a priority. Census numbers have historically been low, so MRMC “dusted off” the program and made improvements to the infrastructure. To start, they created a swing bed team to spearhead the project and provide education to nurses. They hired an occupational therapist to augment physical therapy. This will enable them to be more competitive by providing more and better services. They are doing more focused marketing and outreach in the community and are working more closely internally with their providers and case managers and changing the perception of staff. Revamping the program has increased census from 2 patients a month to 1-3 patients a week.
They stay committed to improving the patient's emergency department experience. Accomplishments include better use of electronic medical records by providers, holding town hall meetings with staff, educating nurses about teach back to assist with smoother transition of care and focusing on expectations of professionalism and increasing accountability for all staff. They are presently looking at the opportunity to create an urgent care clinic adjacent to the emergency department and utilizing UAMS residents in care.
MRMC fully implemented 340B Contracted Retail Pharmacy Program with huge success. The income is assisting them in the enhancement of those services, and they can offer new services such as chemotherapy medication.
To improve revenue cycle (RC) functionality, they created a core RC integrity team that meets bi-weekly. They immediately implemented a manual process for the patient estimator and will review automated process. Key performance indicators (KPIs) have been determined and they decided to use Healthcare Financial Management Association (HFMA) Map to establish targets. Targets for department statistics will be reviewed, developed and rolled into a dashboard. MRMC created three sub-teams: one to address scheduling/pre-registration issues, one to address charging and coding and one to explore denials management. These groups have been working for about two months and are identifying issues and making changes, most recently identifying miscoding that resulted in lost charges.
Surgery volume is increasing. MRMC worked with primary care providers around referral sources and data. A recently added OB/GYN is getting busier. Scope volume has increased, and they plan to refocus on their wound care program (hyperbolic oxygen treatment).
Q: What are some of the outcomes from this project and ways it impacted your hospital and community?
A: Even during the transition to a new CEO, MRMC identified several accomplishments. They increased net income by $1,761,501 and net patient revenue by $849,734. They increased days cash on hand from pre-project 89 to post-project 104 days. In addition, they met both HCAHPS goals for items “willingness to recommend” and “rate the hospital.”
Non-measurable outcomes include:
- Better ownership by managers
- Better cross communication among managers
- Becoming more “de-siloed”
- Excitement around 340B
- Examination of staffing patterns and “how we do business”
- More willing to do business differently rather than “that’s how we’ve always done things”
- Changing staff perception of swing bed program
- Improved community perception as administration hears from medical staff and community that they are seeing positive changes
Q: How do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?
A: The project is helping MRMC to be more efficient and realign resources for a fiscally sound hospital. “(The project) helps to focus on the things that need to be focused on.”