Pender Community Hospital Surpassing Project Goals

May 2016
National Rural Health Resource Center (The Center)

Pender Community Hospital (PCH) located in Pender, Nebraska is a 21-bed critical access hospital whose vision is “to be the best place to get care and the best place to give care.” In addition to acute and emergency care, they provide cardiopulmonary/sleep services, diabetes education, geriatric assessment, imaging, obstetrics and gynecology services. Specialty clinics include audiology, cardiology, counseling, ear, nose and throat, gastroenterology, nephrology, neurology, OB/GYN, oncology, ophthalmology, orthopedics, podiatry, pulmonology, urology, surgery and wound/ostomy/continence/foot and nail care.<--break->" title="">Eric Shell, Director, and Lindsay Corcoran, Consultant, with Stroudwater Associates, worked with PCH in 2015, through the Small Rural Hospital Transition (SRHT) project, on a Financial Operational Assessment (FOA) project. RHI staff spoke with Melissa Kelly, Chief Executive Officer, concerning their progress with this project.

Q: What are some of your hospital's successes regarding implementation of consultant recommendations?
  “Phenomenal project and worth every minute of the effort.” The number one takeaway was to move the clinic to the hospital campus. PCH immediately started plans to build on to the hospital and has set a goal to open December 2017. They have selected an architect and are in the middle of the design process and will start construction by August or September of this year. This has already impacted recruitment of physicians in a huge way and is a big incentive for physicians to join them while also impacting staff morale and community perception.

PCH had started 340B but the consultant held “our feet to fire” and helped to create a sense of urgency. This pushed the hospital to focus on this immediately and resulted in a net of $500k. The nursing home which is “sister” to PCH and has a retail pharmacy has netted $450k which totals to almost $1million net together!

Another focus was swing bed and they were encouraged to set a goal of a minimum daily census of five patients. The utilization review manager worked hard to address this challenge and focused on marketing, outreach to doctors, distributing flyers and making site visits. As a result of her hard work, since January 1, 2016, they had a daily census of 7-8 patients…surpassing their goals! 

The respiratory department has operationally become its own department taking over EKG's and holter monitoring so that radiology can focus on implementing their recommendation of the SRHT project. As a result, MRI has come in-house and they set a target of eleven MRIs monthly to justify an in-house unit. In five months, they have had 14 plus MRI’s each month…again surpassing their goals! 

PCH continues to address productivity statistics around therapy programs. They now have a new contract person and in one month, have doubled revenue with just small tweaks. They plan to continue looking at bigger changes and expect rehab revenue to grow by $400k gross over the course of the fiscal year! 

Through the SRHT project, PCH was encouraged to think more strategically. They completed strategic planning for the organization and set twelve action plans based on consultant and board recommendations. They created roles and responsibilities to move the actions forward and truly let people lead and be independent in projects.

While PCH had very high quality scores, the consultant pointed out that they had not been broadcasting those. They now involve staff to help talk about this accomplishment and created a marketing position to focus on this. 

Concerning the cost report, several changes were made quickly based on consultant recommendations. Days in accounts receivable (AR) is better at 45 days or less and they continue to work on this because “(we) are not quite there yet”. They cross-trained staff so if someone is out, they are no longer holding charges and they identified areas that slowed down the process. They encourage cross-training in clinical departments as well. They continue to address issues so that they can avoid reprocessing of claims. 

Regarding clinical quality, PCH implemented health coaching as part of their Accountable Care Organization (ACO) and focused on readmissions. They have not had a readmission since November 2015 and attribute a large part of this to their focus on exceptional plans of care.

Q: What are the expected next steps towards adopting these recommendations? 
 One focus is on market share. PCH saw opportunities in zip codes where they have clinics and are drilling down to see “why” they are low in market share in those places. They are evaluating services or changes needed. For example, they are looking at either renovating or considering a new building for one of their clinics and may look at adding pharmaceutical services since pharmacy is not offered in that community. They are working closely with the village to discuss having “main street” frontage. 

They will upgrade digital mammography in July. They plan to make information technology a strategic driver. They will have a new manager start and will onboard that person as part of the strategic management team.

PCH is just starting to address population health management and beginning to explore documentation for primary care medical home (PCMH). They have created a committee to take this on.

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?
 PCH surpassed their goal to increase total net margin. The non-measurable impact from the SRHT project include:

  • More physician interest in joining hospital (recruitment)
  • Improved perception by community
  • Viewed as “up and coming” organization
  • Improved staff morale
  • More partnership with communities
  • Leadership is more engaged and they are heading up projects on their own
  • Increased accountability of leadership-progress continues even when CEO is out
  • Better accountability of staff
  • Enhanced leadership development
  • Aligned each leader’s goals with their evaluation/performance
  • Culture of moving things forward more quickly with others being empowered

Q: How do you believe this project has helped you move forward in the newly emerging system of health care delivery and payment?
 “We are setting selves up to be prepared for the ‘jump’ to a new system of delivery and payment. We are setting goals around preventative services and trying to change the community’s view about those by changing communication with the community about prevention. To create that new mindset, we are using new language such as “we’ll see you next year for…” so they think differently and don’t think they should just come in when sick.”