Marcum & Wallace Memorial Hospital Successfully Impacts Project Outcomes

August 2016
National Rural Health Resource Center (The Center)

Marcum & Wallace Memorial Hospital (MWMH) is a 25-bed, not-for-profit Critical Access Hospital (CAH), providing acute care, emergency medicine, swing bed, rehabilitation therapies, imaging, lab, and primary care through its three Rural Health Clinics (RHC), to the residents of Irvine, KY and surrounding communities. MWMH is affiliated with Mercy Health, formally Catholic Health Partners. They were recently awarded the Kentucky Hospital Association (KHA) Quality Award presented to honor hospital leadership and innovation in quality, safety and commitment in patient care. MWMH has also been recognized by iVantage Health Analytics for its accomplishments in rural healthcare quality, reflecting top performance among all rural healthcare providers across the nation.

Eric Shell, Director, and Lindsay Corcoran, Consultant, with Stroudwater Associates, worked with MWMH in 2015, through the Small Rural Hospital Transition (SRHT) project, on a Financial Operational Assessment (FOA). RHI staff spoke with Susan Starling, Chief Executive Officer (CEO) and Elizabeth Walling, Vice President of Operations, concerning their progress with this project. 

Q: What are some of your hospital's successes regarding implementation of consultant recommendations?
 MWMH has been successful addressing a number of clinical priorities that were addressed by the team from Stroudwater. The emergency department (ED) has made significant progress on implementation of the action plan created by the team during Eric's second onsite visit. The changes implemented have supported initiatives to improve the patient's experience while visiting the ED, including reducing the patient's overall length of stay, reducing door to doctor times and decreasing left without being seen. Ultimately, we have increased patient satisfaction which has had a direct impact on improving volumes. The swing bed program is experiencing growth and we have started tracking indicators to demonstrate the value of our program to our community and other facilities we serve. Tracking data on our swing bed program and outcomes is essential as we move towards value-based care. The quality improvement (QI) department is talking more about core measures and created a new scorecard to improve communication with staff and board of directors. MWMH is very aware of the need to align with primary care providers (PCP). Three new providers and one mid-level provider have been added to the team. 

Eric Shell provided several educational sessions to the board of directors. The board gained a better understanding of how they can improve their role to ensure future success of the hospital and this has ultimately improved Board engagement. With a better understanding of healthcare environment, our board members are more comfortable contacting their legislators to address rural health care issues. 

The final report was used as a framework for our master facility planning process. Eric's information provided the groundwork for our consultants, as they help us plan our facility for the future. 

Cost report issues are being addressed. MWMH has reviewed the recommendations and have changed our nursing allocation, and other recommendations based on the findings have been implemented. Revenue cycle management is ongoing and can be challenging sometimes since the hospital is part of a bigger system. We have conducted a strategic pricing assessment for outpatient services with a focus on the radiology department, making changes that allow us to be competitive within our market.

Recommendations regarding 340B have been implemented. The pharmacist is involved with creating strategies to increase utilization for patients and in-house savings. Population health statistics are being measured at the clinics and will be utilized to develop strategies to address compliance and improve preventive services. 

Overall, the project helped us validate our direction and provide a roadmap for the future. As we worked to implement changes that involved others, using Eric's name provided us credibility and helped with navigation through systems.

Q: What are the expected next steps towards adopting these recommendations?
 MWMH is currently conducting master facility planning. They will also continue to address ED improvements and exploring chest pain accreditation. They are assessing the need for new services and creating a strong transfer program. And of course, primary care alignment and relationship building continue to be the highest of priorities. 

Q: What are some of the outcomes from this project, both measurable outcomes and those that aren't measurable but demonstrate the impact of this project on your hospital and community? 
A: The project impacted MWMH in a number of ways which will improve their sustainability. Some of the non-measurable outcomes include:

  • Board increased engagement, better understanding of the future direction of healthcare and the changes specifically related to CAH
  • Increased community involvement
  • Leadership has a better understanding of population health and future direction
  • More buy-in for the need for change - from Board & Management team
  • Increased focus on value added activities, so they aren't just "spinning their wheels"
  • More pride in the things they do well that they didn't realize they were doing well before
  • "Reaffirmed what great managers we have"

Measurable Outcomes

  • Emergency Room Improvements
    • Door to Provider times- decreased from 46 mins (2014) to 21mins (2016)
    • Average Length of Stay-decreased from 204 mins (2014) to 108 mins (2016)
    • Left without being seen rate-decreased from 3.14%(2014) to 1.1% (2016)
  • Swing Bed Program
    • Average Daily Census 8.87 (2016) - Target greater than 4 
  • 340B Pharmacy Program
    • $583,603 (annualized 2016)- compared to $260,000 (2014)
    • In-house pharmacy savings from drug purchases- $16,000 (2016)
  • Primary Care
    • 4 new primary care providers
    • Expanded clinic hours in all three primary care clinics
    • Weekend clinic opening in September 2016

Q: How do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?
 This project provided a much clearer understanding of how to move forward for the future. As a result, there is more willingness to change. The project and report created a pathway to success.

Hospital Spotlight

Uvalde Memorial Hospital Strategizes SRHT Implementation

June 2018

UMH successfully incorporated the ten action items recommended in their 2017 FOA strategic plan. The teams modified time frame goals to coincide with the strategic plan to stay focused on the implementation.

Hospital Spotlight

Delta Memorial Hospital’s SEAL Team

May 2018

Delta Memorial Hospital was spotlighted in November 2017 for the progress on their QI project. Read this next spotlight which talks about their SEAL team, charged with the task of impacting patient experience.

Hospital Spotlight

Delta Memorial Hospital: SRHT Project Well Under Way

November 2017

After only six months of their SRHT QI Project implementation, DMH is reporting successes including the start of a chronic care management program, creation of a patient satisfaction committee and an innovative approach to leadership rounds.

Hospital Spotlight

Coteau des Prairies Keeping Services Close to Home

August 2017

CDP staff is more aware of the ways they impact the financial success of the hospital. There is increased trust of the new leadership team, as well as, improved communication and problem solving.

Hospital Spotlight

Monroe County Hospital Achieving Outcomes

April 2017

Monroe County Hospital completed a Quality of Care and Transition of Care SHRT Project in 2016. Read about their progress on this project.

Hospital Spotlight

Pender Community Hospital Surpassing Project Goals

May 2016

Melissa Kelly, CEO of Pender Community Hospital in Nebraska shares ways they utilized the recommendations from a Financial Operational Assessment to “jump to new system of delivery and payment.” They describe how they are setting goals around preventative services and trying to change the community’s view by changing communication with the community about prevention.

Hospital Spotlight

Spotlight on Cibola General Hospital

February 2016

CGH completed a QI and TOC Project in 2015. Bob Phillips, CEO and co-CNOs share how they used the recommendations to prepare to be a part of an ACO and creating processes to support population health.

Hospital Spotlight

Spotlight on Missouri Delta Medical Center

June 2015

MDMC shares successes and lessons learned from an RHPI FOA in preparing for a new payment and care delivery model and discusses next steps for participation in a shared savings plan and/or ACO.

Hospital Spotlight

Spotlight on Tallahatchie General Hospital

April 2015

Jim Blackwood, Administrator of TGH, discusses ways they used an RHPI FOA to focus on developing leadership abilities, especially regarding handling the “business” end of their departments.

Hospital Spotlight

St. James Parish Hospital’s Lean Project Success

December 2014

St. James Parish Hospital worked on a Lean Process Planning & Value Stream Mapping RHPI Project. The team chose to focus on medication management and medical necessity.

Hospital Spotlight

LaSalle General Hospital Improves Clinical Processes and Revenue Cycle

February 2012

This project helped to provide assistance with evaluating clinical processes that impact the revenue cycle, prioritize needs, develop action plans based on the identified needs and implement a plan to improve clinical processes and thus the revenue cycle.