Marcum & Wallace Memorial Hospital Successfully Impacts Project Outcomes

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?A: 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?A: 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?A: 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.